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General NPI Number Information
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NPI Number | 1538588611
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Entity Type | Individual
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Provider Name | KATHRYN ALICE BAUDREAU LICSW
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Gender |
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 373 BLAIR PARK RD UNIT 206
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City | WILLISTON
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State | VT
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Zip | 05495-8056
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Country | US
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Telephone | 802-316-8717
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Fax |
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Provider Business Mailing Address
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Address Line | 150 DORSET ST SUITE 245 PMB 247
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403
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Country | US
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Telephone | 802-316-8717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089.0093217
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License Number State | VT
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