Healthcare Provider Details

I. General information

NPI: 1770935314
Provider Name (Legal Business Name): ESSENTIAL WELLNESS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 DEWEY ST
BENNINGTON VT
05201-2253
US

IV. Provider business mailing address

1151 NW HILL RD
POWNAL VT
05261-9448
US

V. Phone/Fax

Practice location:
  • Phone: 802-445-3039
  • Fax: 802-445-3026
Mailing address:
  • Phone: 802-558-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WENDY L LEFFEL
Title or Position: MEMBER-MANAGER
Credential: MD
Phone: 802-558-5656