MEDICARE: MICHELLE LEE SPAULDING 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	103TC0700X	Clinical Psychologist	0470046107	VT

General Provider Information

NPI Number	:	1740418193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LEE SPAULDING M.A.

Provider Business Mailing Address
First Line	:	75 FAIRFIELD ST
Second Line	:
City	:	SAINT ALBANS
State	:	VT
Zip	:	05478-2051
Country	:	US
Telephone Number	:	802-598-8284
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 FAIRFIELD ST
Second Line	:
City	:	SAINT ALBANS
State	:	VT
Zip	:	05478-2051
Country	:	US
Telephone Number	:	802-598-8284
Fax Number	:

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

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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