Healthcare Provider Details

I. General information

NPI: 1558255091
Provider Name (Legal Business Name): ZACHARY JEPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PINE ST
RUTLAND VT
05701-2842
US

IV. Provider business mailing address

17 HARRISON AVE
WEST RUTLAND VT
05777-9388
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-0864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: