MEDICARE: KATHRYN ALICE BAUDREAU LICSW

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	1041C0700X	Clinical Social Worker	089.0093217	VT

General Provider Information

NPI Number	:	1538588611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ALICE BAUDREAU LICSW

Provider Business Mailing Address
First Line	:	150 DORSET ST SUITE 245
Second Line	:	PMB 247
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403
Country	:	US
Telephone Number	:	802-316-8717
Fax Number	:

Provider Business Practice Location Address
First Line	:	373 BLAIR PARK RD UNIT 206
Second Line	:
City	:	WILLISTON
State	:	VT
Zip	:	05495-8056
Country	:	US
Telephone Number	:	802-316-8717
Fax Number	:

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

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	07/30/2024

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