Provider Demographics
NPI:1881824803
Name:JERSILD, DEVON (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEVON
Middle Name:
Last Name:JERSILD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 MORGAN HORSE FARM RD
Mailing Address - Street 2:
Mailing Address - City:WEYBRIDGE
Mailing Address - State:VT
Mailing Address - Zip Code:05753-9779
Mailing Address - Country:US
Mailing Address - Phone:802-545-2552
Mailing Address - Fax:
Practice Address - Street 1:1641 MORGAN HORSE FARM RD
Practice Address - Street 2:
Practice Address - City:WEYBRIDGE
Practice Address - State:VT
Practice Address - Zip Code:05753-9779
Practice Address - Country:US
Practice Address - Phone:802-545-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480054950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical