Provider Demographics
NPI:1265598460
Name:PLO, JEANNE EVELYN (MED, MA)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:EVELYN
Last Name:PLO
Suffix:
Gender:F
Credentials:MED, MA
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:EVELYN
Other - Last Name:PLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED,MA,LCMHC
Mailing Address - Street 1:416 S WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4016
Mailing Address - Country:US
Mailing Address - Phone:802-862-0836
Mailing Address - Fax:802-860-2399
Practice Address - Street 1:168 BATTERY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5285
Practice Address - Country:US
Practice Address - Phone:802-862-0836
Practice Address - Fax:802-860-2399
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00680000065OtherMENTAL HEALTH COUNSELOR
VT1007143Medicaid