Healthcare Provider Details

I. General information

NPI: 1033055496
Provider Name (Legal Business Name): JENNA BRICKNER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 QUECHEE MAIN ST UNIT 1C
QUECHEE VT
05059-3013
US

IV. Provider business mailing address

317 BROOK RD
STRAFFORD VT
05072-9774
US

V. Phone/Fax

Practice location:
  • Phone: 802-249-4751
  • Fax:
Mailing address:
  • Phone: 802-249-4751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11009
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: