Healthcare Provider Details

I. General information

NPI: 1164587481
Provider Name (Legal Business Name): JACK J. HEDDON M.A., NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 FAIRVIEW STREET
BRATTLEBORO VT
05301-8881
US

IV. Provider business mailing address

390 RIVER ST
SPRINGFIELD VT
05156-2226
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-6028
  • Fax: 802-254-7501
Mailing address:
  • Phone: 802-886-4500
  • Fax: 802-886-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2593
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number097.0121746
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0122899
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: