Healthcare Provider Details

I. General information

NPI: 1154856185
Provider Name (Legal Business Name): JENNIFER DONAHUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 FARMVU DR
WHITE RIVER JUNCTION VT
05001-6001
US

IV. Provider business mailing address

92 FARMVU DR
WHITE RIVER JUNCTION VT
05001-6001
US

V. Phone/Fax

Practice location:
  • Phone: 802-698-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: