Healthcare Provider Details

I. General information

NPI: 1366306813
Provider Name (Legal Business Name): CHAMPLAIN VALLEY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 SHELBURNE ROAD SUITE 300
SHELBURNE VT
05482
US

IV. Provider business mailing address

5420 SHELBURNE ROAD SUITE 300
SHELBURNE VT
05482
US

V. Phone/Fax

Practice location:
  • Phone: 802-383-1234
  • Fax: 802-383-1242
Mailing address:
  • Phone: 802-383-1234
  • Fax: 802-383-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY MARCKRES
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 802-482-7522