Healthcare Provider Details

I. General information

NPI: 1922128651
Provider Name (Legal Business Name): JACQUELINE MARIE VACHON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 MAIN ST
LAFAYETTE IN
47901-1451
US

IV. Provider business mailing address

610 MAIN ST
LAFAYETTE IN
47901-1451
US

V. Phone/Fax

Practice location:
  • Phone: 765-428-2242
  • Fax: 765-742-4196
Mailing address:
  • Phone: 765-428-2242
  • Fax: 765-742-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: