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NPI Code Detail

MEDICARE: EMILY KALLOCK

MEDICARE: EMILY KALLOCK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor089.0001004VT

General Provider Information

NPI Number : 1083483234
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY KALLOCK
Provider Business Mailing Address
First Line : 89 MAIN ST
Second Line :
City : MIDDLEBURY
State : VT
Zip : 05753-1483
Country : US
Telephone Number : 802-388-6751
Fax Number : 802-388-3108
Provider Business Practice Location Address
First Line : 89 MAIN ST
Second Line :
City : MIDDLEBURY
State : VT
Zip : 05753-1483
Country : US
Telephone Number : 802-388-6751
Fax Number : 802-388-3108
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2023
Last Update Date : 12/29/2023

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Directions to “ EMILY KALLOCK ” Practice Location

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