Healthcare Provider Details

I. General information

NPI: 1306760681
Provider Name (Legal Business Name): KRISTI TEMPLETON CLARK LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MAIN ST
WHITE RIVER JUNCTION VT
05009-0001
US

IV. Provider business mailing address

42B HIGH ST
WOODSTOCK VT
05091-1310
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-9363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number097.0136163
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: