Healthcare Provider Details

I. General information

NPI: 1962521559
Provider Name (Legal Business Name): JENNIFER MARIE HALL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

1 S PROSPECT ST
BURLINGTON VT
05401-3456
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-8016
  • Fax: 802-847-8047
Mailing address:
  • Phone: 802-847-8016
  • Fax: 802-847-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0320085183
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: