Provider Demographics
NPI:1457967028
Name:FJELD, JESSIE CATHERINE
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:CATHERINE
Last Name:FJELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9781
Mailing Address - Country:US
Mailing Address - Phone:207-298-7662
Mailing Address - Fax:
Practice Address - Street 1:28 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9781
Practice Address - Country:US
Practice Address - Phone:207-298-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-19
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117440235Z00000X
MESP3683235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty