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General NPI Number Information
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NPI Number | 1578604310
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF VERMONT AND STATE AGRICULTURAL COLLEGE
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 01/21/2010
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Provider Practice Location Address
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Address Line | 489 MAIN ST POMEROY HALL
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City | BURLINGTON
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State | VT
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Zip | 05405-1709
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Country | US
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Telephone | 802-656-3861
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Fax | 802-656-2528
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Provider Business Mailing Address
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Address Line | 489 MAIN ST POMEROY HALL
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City | BURLINGTON
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State | VT
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Zip | 05405-1709
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Country | US
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Telephone | 802-656-3861
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Fax | 802-656-2528
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MOIRA MULLIGAN
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Credential | CCC-SLP
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Telephone | 802-656-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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