Provider Demographics
NPI:1467130328
Name:JENNIFER FELLOWS LICSW, LLC
Entity Type:Organization
Organization Name:JENNIFER FELLOWS LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-233-7420
Mailing Address - Street 1:291 PILLSBURY LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8728
Mailing Address - Country:US
Mailing Address - Phone:802-233-7420
Mailing Address - Fax:
Practice Address - Street 1:1795 WILLISTON RD STE 330
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6487
Practice Address - Country:US
Practice Address - Phone:802-233-7420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty