Provider Demographics
NPI:1457412116
Name:UTTECHT, JENNIFER S (PSY D)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:UTTECHT
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5353
Mailing Address - Country:US
Mailing Address - Phone:802-863-1326
Mailing Address - Fax:802-660-3665
Practice Address - Street 1:1138 PINE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5353
Practice Address - Country:US
Practice Address - Phone:802-863-1326
Practice Address - Fax:802-660-3665
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical