Healthcare Provider Details

I. General information

NPI: 1750208716
Provider Name (Legal Business Name): KATHLEEN JEANNE GERENCER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KASEY GERENCER

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COLCHESTER AVE
BURLINGTON VT
05405-1764
US

IV. Provider business mailing address

2 COLCHESTER AVE
BURLINGTON VT
05405-1764
US

V. Phone/Fax

Practice location:
  • Phone: 802-656-2661
  • Fax:
Mailing address:
  • Phone: 802-656-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number097.0137000
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: