MEDICARE: MS. JILL L. CRESWELL M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	47-0000571	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003951781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL L. CRESWELL M.S.

Provider Business Mailing Address
First Line	:	162 ELM ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-2896
Country	:	US
Telephone Number	:	802-223-6946
Fax Number	:

Provider Business Practice Location Address
First Line	:	162 ELM ST
Second Line	:
City	:	MONTPELIER
State	:	VT
Zip	:	05602-0000
Country	:	US
Telephone Number	:	802-223-6946
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	01/31/2017

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