Healthcare Provider Details

I. General information

NPI: 1891974812
Provider Name (Legal Business Name): JENNIFER JOELLE WEIER O'PHINNEY M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 TALCOTT RD SUITE 206
WILLISTON VT
05495-2089
US

IV. Provider business mailing address

183 TALCOTT RD SUITE 206
WILLISTON VT
05495-2089
US

V. Phone/Fax

Practice location:
  • Phone: 802-876-1100
  • Fax: 802-876-1101
Mailing address:
  • Phone: 802-876-1100
  • Fax: 802-876-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number047-0000728
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: