Provider Demographics
NPI:1770590663
Name:MCLEOD, DIANA WASHBURN (MACP RN)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:WASHBURN
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:MACP RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2165
Mailing Address - Country:US
Mailing Address - Phone:802-229-5296
Mailing Address - Fax:802-229-1406
Practice Address - Street 1:35 TERRACE ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2165
Practice Address - Country:US
Practice Address - Phone:802-229-5296
Practice Address - Fax:802-229-1406
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT47-537103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008386OtherCIGNA
VT28419OtherBCBS
VT1003873Medicaid
VT41531OtherMVP