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General NPI Number Information
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NPI Number | 1730497504
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Entity Type | Organization
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Legal Business Name | JACQUELYN E. BODE, M.ED., INC.
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 73 CENTER ST
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City | RUTLAND
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State | VT
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Zip | 05701-4046
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Country | US
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Telephone | 802-747-3488
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Fax | 802-747-0006
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Provider Business Mailing Address
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Address Line | 73 CENTER ST
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City | RUTLAND
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State | VT
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Zip | 05701-4046
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Country | US
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Telephone | 802-747-3488
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Fax | 802-747-0006
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JACQUELYN ELLEN BODE
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Credential | M.ED.
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Telephone | 802-747-3488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 047.0000269
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License Number State | VT
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