Provider Demographics
NPI:1891420360
Name:ALLMAN, JACQUELINE K (MS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:ALLMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:PATRICIA
Other - Last Name:KELK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4560
Practice Address - Street 1:132 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7234
Practice Address - Country:US
Practice Address - Phone:802-295-3031
Practice Address - Fax:802-295-0820
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0135345101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional