Healthcare Provider Details

I. General information

NPI: 1427262138
Provider Name (Legal Business Name): MICHAEL WILLIAM KESLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N MAIN ST
WALLINGFORD VT
05773-9800
US

IV. Provider business mailing address

167 N MAIN ST
WALLINGFORD VT
05773-9800
US

V. Phone/Fax

Practice location:
  • Phone: 802-446-3577
  • Fax: 802-446-3801
Mailing address:
  • Phone: 802-446-3577
  • Fax: 802-446-3801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number014595-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number048.0134183
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: