Healthcare Provider Details

I. General information

NPI: 1669382248
Provider Name (Legal Business Name): WILLOW AEVERY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STATE ST
MONTPELIER VT
05602-2957
US

IV. Provider business mailing address

9 LINCOLN AVE
MONTPELIER VT
05602-2453
US

V. Phone/Fax

Practice location:
  • Phone: 802-839-5345
  • Fax:
Mailing address:
  • Phone: 802-839-5345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097.0136151
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: