Kaitlyn Desjardin

Primary specialty

AudiologistTaxonomy code 231H00000X

License

000619 Issued in CT

Practice address

Crec-Soundbridge
123 Progress Drive
Wethersfield, CT 06109-0610

Phone

(860) 529-4260

Fax

(860) 257-8500

NPI assigned

Apr 9, 2019

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 9, 2019.

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1154884047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CREC-SOUNDBRIDGE",
            "address_2": "123 PROGRESS DRIVE",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061092450",
            "telephone_number": "860-529-4260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CREC-SOUNDBRIDGE",
            "address_2": "123 PROGRESS DRIVE",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061090610",
            "telephone_number": "860-529-4260",
            "fax_number": "860-257-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESJARDIN",
        "first_name": "KAITLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CT",
            "license": "000619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "000619",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Antonella Dellaripa
• Alexandra Demosthene, LPC
• Melissa Dennis, LPC
• Dental Associates of Wethersfield
• Dental Associates of Wethersfield, PLLC
• Orlando Diaz, CRNA
• Michael Dibiase
• Sharon Digioia Daskal, LCSW
• Matthew D Dionne, LMSW
• Jaimee Lee Dmowski, DPT

• All providers in Wethersfield, CT
• Audiologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.