Provider Demographics
NPI:1831337971
Name:DESJARDINS, JANE S (CCC, SLP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:S
Last Name:DESJARDINS
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 S WESTSHORE BLVD
Mailing Address - Street 2:APT 617
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-2912
Mailing Address - Country:US
Mailing Address - Phone:813-598-2422
Mailing Address - Fax:
Practice Address - Street 1:6401 S WESTSHORE BLVD
Practice Address - Street 2:APT 617
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33616-2912
Practice Address - Country:US
Practice Address - Phone:813-598-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist