Healthcare Provider Details

I. General information

NPI: 1700295664
Provider Name (Legal Business Name): LYNETTE HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2014
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 BROAD BROOK RD
VERNON VT
05354-9705
US

IV. Provider business mailing address

262 BROAD BROOK RD
VERNON VT
05354-9705
US

V. Phone/Fax

Practice location:
  • Phone: 802-257-3532
  • Fax: 208-692-0759
Mailing address:
  • Phone: 802-257-3532
  • Fax: 208-692-0759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-07-3758
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: