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Individual

KAREN LEE GILLOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
115 ETNA RD, BUILDING 1, SUITE 2, LEBANON, NH 03766-1429
(603) 448-3588
(603) 448-3583
Mailing address
PO BOX 769, WHITE RIVER JUNCTION, VT 05001-0769
(603) 448-3588
(603) 448-3583

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
943
NH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1008149
MEDICAID
VT
05
30421560
NH
Enumeration date
12/01/2006
Last updated
03/31/2009
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