Provider Demographics
NPI:1881225258
Name:REPSTAD, ELLEN (MSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:REPSTAD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 ROCKYDALE RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-5247
Mailing Address - Country:US
Mailing Address - Phone:802-782-2426
Mailing Address - Fax:
Practice Address - Street 1:312 ROCKYDALE RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-5247
Practice Address - Country:US
Practice Address - Phone:802-782-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical