Provider Demographics
NPI:1689259921
Name:ETTLINGER, TRUDEE (PHD, APRN, LADC)
Entity Type:Individual
Prefix:
First Name:TRUDEE
Middle Name:
Last Name:ETTLINGER
Suffix:
Gender:F
Credentials:PHD, APRN, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 HEGEMAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3109
Mailing Address - Country:US
Mailing Address - Phone:802-661-4376
Mailing Address - Fax:
Practice Address - Street 1:162 HEGEMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3109
Practice Address - Country:US
Practice Address - Phone:802-661-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0009090363LP0808X
VT151.0126250101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)