Provider Demographics
NPI:1518988666
Name:ST.JOHN, JOANNE THUESEN (LADC)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:THUESEN
Last Name:ST.JOHN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1459
Mailing Address - Country:US
Mailing Address - Phone:802-388-6751
Mailing Address - Fax:802-388-3108
Practice Address - Street 1:220 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1235
Practice Address - Country:US
Practice Address - Phone:802-453-2333
Practice Address - Fax:802-453-4359
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000238101YA0400X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor