Provider Demographics
NPI:1477688968
Name:LEINWOHL, CAROL KIEWIT
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:KIEWIT
Last Name:LEINWOHL
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 1:81 NORWAY DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-9648
Mailing Address - Country:US
Mailing Address - Phone:802-863-8082
Mailing Address - Fax:
Practice Address - Street 1:133 BLAKELY RD
Practice Address - Street 2:SUITE 207
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4007
Practice Address - Country:US
Practice Address - Phone:802-865-6815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000380101YM0800X
VT047-0000697103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006717Medicaid