Provider Demographics
NPI:1265815690
Name:WAHLERS, SALISSA (LICSW)
Entity Type:Individual
Prefix:
First Name:SALISSA
Middle Name:
Last Name:WAHLERS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LAKESIDE AVE
Mailing Address - Street 2:STE 260
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4939
Mailing Address - Country:US
Mailing Address - Phone:802-657-7000
Mailing Address - Fax:
Practice Address - Street 1:128 LAKESIDE AVE
Practice Address - Street 2:STE 260
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4939
Practice Address - Country:US
Practice Address - Phone:802-657-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00861501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical