Provider Demographics
NPI:1790193985
Name:SANBORN, JENNIFER (MS, LADC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SANBORN
Suffix:
Gender:F
Credentials:MS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 MAPLE TREE PL # 1055
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8210
Mailing Address - Country:US
Mailing Address - Phone:802-304-0284
Mailing Address - Fax:802-419-5376
Practice Address - Street 1:1375 MAPLE TREE PL # 1055
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8210
Practice Address - Country:US
Practice Address - Phone:802-304-0284
Practice Address - Fax:802-419-5376
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1551101YA0400X
VT151.0126903101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty