Provider Demographics
NPI:1114154044
Name:TRUDEAU, KRISTIN (MA, LADC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:TRUDEAU
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 NEW ENGLAND POWER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILMINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05363-9764
Mailing Address - Country:US
Mailing Address - Phone:802-345-7392
Mailing Address - Fax:
Practice Address - Street 1:38 NEW ENGLAND POWER RD
Practice Address - Street 2:SUITE B
Practice Address - City:WILMINGTON
Practice Address - State:VT
Practice Address - Zip Code:05363-9764
Practice Address - Country:US
Practice Address - Phone:802-345-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000436101YA0400X
VT104078101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)