Healthcare Provider Details

I. General information

NPI: 1396837241
Provider Name (Legal Business Name): JENNIFER AUDETTE MS, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 AUSTINE DR STE 210
BRATTLEBORO VT
05301-6994
US

IV. Provider business mailing address

87 FAIRGROUND RD
SPRINGFIELD VT
05156-2100
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-3922
  • Fax: 802-258-9512
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: