Individual
ETHAN W GILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
476 MAIN ST, WINOOSKI, VT 05404-1300
(802) 363-1602
Mailing address
PO BOX 102, WINOOSKI, VT 05404-0102
(802) 363-1602
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
000728
VT
Other
Enumeration date
09/12/2016
Last updated
09/12/2016
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