Provider Demographics
NPI:1609398197
Name:HULTGREN, TRACIE BERNADETTE (MA IN COUNSELING)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:BERNADETTE
Last Name:HULTGREN
Suffix:
Gender:F
Credentials:MA IN COUNSELING
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 9221
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05407-9221
Mailing Address - Country:US
Mailing Address - Phone:802-324-3022
Mailing Address - Fax:
Practice Address - Street 1:23 VILLEMAIRE LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-3792
Practice Address - Country:US
Practice Address - Phone:802-324-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0092515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health