Provider Demographics
NPI:1396365490
Name:BAXTER, WENDY ELLEN
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ELLEN
Last Name:BAXTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WEST ST
Mailing Address - Street 2:
Mailing Address - City:DUMMERSTON
Mailing Address - State:VT
Mailing Address - Zip Code:05301-9660
Mailing Address - Country:US
Mailing Address - Phone:802-258-0466
Mailing Address - Fax:
Practice Address - Street 1:108 WEST ST
Practice Address - Street 2:
Practice Address - City:DUMMERSTON
Practice Address - State:VT
Practice Address - Zip Code:05301-9660
Practice Address - Country:US
Practice Address - Phone:802-258-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0106845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health