Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 047-0000736 | VT |
Y | 103T00000X | Psychologist | 047-0000736 | VT |
NPI | 1003073644 |
---|---|
Provider Name | Ms. Marilyn Jean Renaudette |
First Address | Williston, VT 05495-4408 |
Second Address | Williston, VT 05495-7695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 03/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1015179 | (05) | VT |