Healthcare Provider Details

I. General information

NPI: 1972752269
Provider Name (Legal Business Name): JESSICA R. HOUSER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MAIN ST
BURLINGTON VT
05401-5216
US

IV. Provider business mailing address

3 MAIN ST
BURLINGTON VT
05401-5216
US

V. Phone/Fax

Practice location:
  • Phone: 802-651-7501
  • Fax:
Mailing address:
  • Phone: 802-651-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number019565
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019565
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number019565
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number048.0118565
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number048.0118565
License Number StateVT
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number048.0118565
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: