Provider Demographics
NPI:1720142615
Name:MOY, JEANETTE W (MS, LAC)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:W
Last Name:MOY
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1335
Mailing Address - Country:US
Mailing Address - Phone:802-363-4545
Mailing Address - Fax:802-864-0274
Practice Address - Street 1:321 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1335
Practice Address - Country:US
Practice Address - Phone:802-363-4545
Practice Address - Fax:802-864-0274
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000116171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist