Provider Demographics
NPI:1740418193
Name:SPAULDING, MICHELLE LEE (MA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:SPAULDING
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-2051
Mailing Address - Country:US
Mailing Address - Phone:802-598-8284
Mailing Address - Fax:
Practice Address - Street 1:75 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-2051
Practice Address - Country:US
Practice Address - Phone:802-598-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0470046107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical