Bode, Jacquelyn Ellen

Bode, Jacquelyn Ellen is an individual health care provider with primary practice located at 73 Center St , Rutland VT 05701-4046. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is her primary health care specialty. Bode, Jacquelyn Ellen can be contacted via phone (802) 747-3488.

Contact Information

Primary practice address
73 Center St Rutland VT 05701-4046
Phone: (802) 747-3488
Fax: (802) 747-0006
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 291 Vermont
Behavioral Health & Social Service Providers / Psychologist 103T00000X 269 Vermont

Profile Details

NPI number 1780782375
LBN Legal business name Bode, Jacquelyn Ellen
Credentials Master of Education (MED)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2006
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780782375 NPPES
Vermont MEDICAID 0002611

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