Healthcare Provider Details

I. General information

NPI: 1174409122
Provider Name (Legal Business Name): JESSA DENTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 FALLS BRIDGE RD
WILLIAMSTOWN VT
05679-8913
US

IV. Provider business mailing address

16 BERGERON ST APT 1
BARRE VT
05641-5424
US

V. Phone/Fax

Practice location:
  • Phone: 802-585-9967
  • Fax:
Mailing address:
  • Phone: 802-585-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: