Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 47-0000571 | VT |
Y | 103T00000X | Psychologist | 47-0000571 | VT |
NPI | 1003951781 |
---|---|
Provider Name | Ms. Jill L. Creswell |
First Address | Montpelier, VT 05602-2896 |
Second Address | Montpelier, VT 05602-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 31/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1004004 | (05) | VT |