Individual
JENNIFER AUDETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
25 W INDEPENDENCE WAY, KINGSTON, RI 02881-1124
(401) 874-5625
(401) 874-5630
Mailing address
25 W INDEPENDENCE WAY, KINGSTON, RI 02881-1124
(401) 874-5625
(401) 874-5630
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RI000728
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
411530
BLUE CHIP PROVIDER ID
RI
01
—
64-00196
UNITED HEALTH PROVIDER ID
RI
01
—
7554-9
BLUE CROSS PROVIDER ID
RI
Enumeration date
01/25/2007
Last updated
07/08/2007
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