Healthcare Provider Details

I. General information

NPI: 1922012285
Provider Name (Legal Business Name): ESTELLE L LECLAIR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MARKET PL SUITE #33
ESSEX JCT VT
05452-2942
US

IV. Provider business mailing address

120 TOWERS RD
ESSEX JCT VT
05452-2620
US

V. Phone/Fax

Practice location:
  • Phone: 808-878-9572
  • Fax: 802-878-9592
Mailing address:
  • Phone: 802-878-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0400002668
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: