Provider Demographics
NPI:1922128651
Name:VACHON, JACQUELINE MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:VACHON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1451
Mailing Address - Country:US
Mailing Address - Phone:765-428-2242
Mailing Address - Fax:765-742-4196
Practice Address - Street 1:610 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1451
Practice Address - Country:US
Practice Address - Phone:765-428-2242
Practice Address - Fax:765-742-4196
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health