Provider Demographics
NPI:1922012285
Name:LECLAIR, ESTELLE L (PT)
Entity Type:Individual
Prefix:MRS
First Name:ESTELLE
Middle Name:L
Last Name:LECLAIR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 TOWERS RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX JCT
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2620
Mailing Address - Country:US
Mailing Address - Phone:802-878-9255
Mailing Address - Fax:
Practice Address - Street 1:1 MARKET PL
Practice Address - Street 2:SUITE #33
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-2942
Practice Address - Country:US
Practice Address - Phone:808-878-9572
Practice Address - Fax:802-878-9592
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002668174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011104Medicaid
VT1011104Medicaid