Provider Demographics
NPI:1770260218
Name:SLYNE, JESSIE-FERN LYNN
Entity type:Individual
Prefix:
First Name:JESSIE-FERN
Middle Name:LYNN
Last Name:SLYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JESSIE-FERN
Other - Middle Name:LYNN
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 DORSET XING UNIT 226
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1475
Mailing Address - Country:US
Mailing Address - Phone:413-388-3386
Mailing Address - Fax:
Practice Address - Street 1:835 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2363
Practice Address - Country:US
Practice Address - Phone:860-413-9538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1415103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst