Individual
JESSICA CLARK-KEELER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
160 ALLEN ST, RUTLAND, VT 05701-4560
(802) 775-7111
Mailing address
441 EDMUNDS RD, DANBY, VT 05739-9308
(802) 293-5345
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
890097518
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0890097518
LICENSE
VT
Enumeration date
12/10/2013
Last updated
05/12/2016
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