Individual
JENNIE HOLDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
048.0098981
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00355940
AGENCY MEDICAID
—
01
—
1285628552
AGENCY NPI
—
Enumeration date
07/07/2010
Last updated
11/05/2015
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