Provider Demographics
NPI:1821798489
Name:WALLETT, KATHRYN MITIGUY (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MITIGUY
Last Name:WALLETT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:MITIGUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 ELBERN AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-9006
Mailing Address - Country:US
Mailing Address - Phone:802-558-2986
Mailing Address - Fax:
Practice Address - Street 1:42 ELBERN AVE
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-9006
Practice Address - Country:US
Practice Address - Phone:802-558-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00899511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical