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Individual

ALISON CHICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
130 S MAIN ST, WATERBURY, VT 05676-1519
(802) 244-7874
Mailing address
PO BOX 783, CRESTED BUTTE, CO 81224-0783

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
055-0031470
VT
363A00000X
Physician Assistant
055-0031470
VT
363A00000X
Physician Assistant
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1215403068
CO
Enumeration date
10/19/2018
Last updated
09/10/2020
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