Provider Demographics
NPI:1922150416
Name:RAWSON, JOHANNA ESTHER (LADC)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ESTHER
Last Name:RAWSON
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 BUNKER HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843
Mailing Address - Country:US
Mailing Address - Phone:802-472-6848
Mailing Address - Fax:
Practice Address - Street 1:297 SUMMER ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819
Practice Address - Country:US
Practice Address - Phone:802-748-1682
Practice Address - Fax:802-748-0211
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000386101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor