Healthcare Provider Details

I. General information

NPI: 1598221350
Provider Name (Legal Business Name): MS. JOANNE RUTH BECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GLENDON HILLS RD
BONDVILLE VT
05340-9728
US

IV. Provider business mailing address

10 GLENDON HILLS RD
BONDVILLE VT
05340-9728
US

V. Phone/Fax

Practice location:
  • Phone: 802-779-1819
  • Fax:
Mailing address:
  • Phone: 802-779-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0127979
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: