Healthcare Provider Details

I. General information

NPI: 1275855975
Provider Name (Legal Business Name): SD ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 TALCOTT RD SUITE 114
WILLISTON VT
05495
US

IV. Provider business mailing address

37 TALCOTT RD SUITE 114
WILLISTON VT
05495
US

V. Phone/Fax

Practice location:
  • Phone: 802-662-7831
  • Fax: 802-662-7834
Mailing address:
  • Phone: 802-662-7831
  • Fax: 802-662-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID POWSNER
Title or Position: EXECUTIVE/CLINICAL DIRECTOR
Credential: M.ED, BCBA LBA
Phone: 802-662-7831