Healthcare Provider Details

I. General information

NPI: 1942164819
Provider Name (Legal Business Name): JANESSA LEE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PINE HAVEN SHORES RD STE 1000A
SHELBURNE VT
05482-7812
US

IV. Provider business mailing address

PO BOX 354
ENOSBURG FALLS VT
05450-0354
US

V. Phone/Fax

Practice location:
  • Phone: 802-233-7347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: