Provider Demographics
NPI:1851155089
Name:KASPER, MACKENZIE ANNE (BA)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ANNE
Last Name:KASPER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:ANNE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-0647
Mailing Address - Country:US
Mailing Address - Phone:802-301-3200
Mailing Address - Fax:802-223-0842
Practice Address - Street 1:34 BARRE ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3510
Practice Address - Country:US
Practice Address - Phone:802-301-3200
Practice Address - Fax:802-223-0842
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker