Healthcare Provider Details

I. General information

NPI: 1235625997
Provider Name (Legal Business Name): KASSONDRA GAYLORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 COLLEGE ST N
POULTNEY VT
05764-1047
US

IV. Provider business mailing address

291 COLLEGE ST N
POULTNEY VT
05764-1047
US

V. Phone/Fax

Practice location:
  • Phone: 802-884-5548
  • Fax:
Mailing address:
  • Phone: 802-884-5548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: