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Individual
JEAN ETTER
Active
Individual
JEAN ETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089-0000769
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30420624
—
NH
05
—
OVN2603
—
VT
Enumeration date
07/26/2006
Last updated
07/08/2007
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