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NPI Code Detail

MEDICARE: JULIETTE JACKSON

MEDICARE: JULIETTE JACKSON
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
1101YA0400XAddiction (Substance Use Disorder) Counselor149.0134039VT

General Provider Information

NPI Number : 1659230787
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIETTE JACKSON
Provider Business Mailing Address
First Line : 100 LEDGEHILL RD
Second Line :
City : BENNINGTON
State : VT
Zip : 05201-2273
Country : US
Telephone Number : 802-442-5491
Fax Number :
Provider Business Practice Location Address
First Line : 100 LEDGEHILL RD
Second Line :
City : BENNINGTON
State : VT
Zip : 05201-2273
Country : US
Telephone Number : 802-442-5491
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “ JULIETTE JACKSON ” Practice Location

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