Provider Demographics
NPI:1053667477
Name:WILLIAMSON, JENNIFER (ND)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 COLLEGE STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-578-3449
Mailing Address - Fax:877-816-1002
Practice Address - Street 1:299 COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-578-3449
Practice Address - Fax:877-816-1002
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0990085570175F00000X
VT099.0085570208D00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1020995Medicaid