Provider Demographics
NPI:1598324246
Name:POLLVOGT, ALICE KRISTINA (MA)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:KRISTINA
Last Name:POLLVOGT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VT
Mailing Address - Zip Code:05477-0361
Mailing Address - Country:US
Mailing Address - Phone:802-922-7569
Mailing Address - Fax:
Practice Address - Street 1:185 TILLEY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4484
Practice Address - Country:US
Practice Address - Phone:802-922-7569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0133673103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist