MEDICARE: MS. HOPE CANNON M.A.

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	103TC1900X	Counseling Psychologist	141	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06806149	OTHER	VT	VT BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720045578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOPE CANNON M.A.

Provider Business Mailing Address
First Line	:	PO BOX 413
Second Line	:
City	:	WOODSTOCK
State	:	VT
Zip	:	05091-0413
Country	:	US
Telephone Number	:	802-457-4081
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 ELM ST
Second Line	:	2ND FLOOR
City	:	WOODSTOCK
State	:	VT
Zip	:	05091-1000
Country	:	US
Telephone Number	:	802-457-4081
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	08/03/2007

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