Healthcare Provider Details

I. General information

NPI: 1538025986
Provider Name (Legal Business Name): JOHANNAH H. TALLON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 HOSPITAL LOOP
BERLIN VT
05602-9105
US

IV. Provider business mailing address

PO BOX 647
MONTPELIER VT
05601-0647
US

V. Phone/Fax

Practice location:
  • Phone: 802-479-4083
  • Fax: 802-476-1476
Mailing address:
  • Phone: 802-229-1399
  • Fax: 802-223-8623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number149.0134057
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number097.0136521
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: