Healthcare Provider Details

I. General information

NPI: 1023529864
Provider Name (Legal Business Name): KATRINA M. WHYMAN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 ETTA FRASIER DR
WINDSOR VT
05089-1315
US

IV. Provider business mailing address

141 ETTA FRASIER DR
WINDSOR VT
05089-1315
US

V. Phone/Fax

Practice location:
  • Phone: 802-674-9400
  • Fax:
Mailing address:
  • Phone: 802-674-9400
  • Fax: 802-674-9410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151-0130732
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151.0130732
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0134108
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: