Individual
JOHN PAGE JESSUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST, MA
Contact information
Practice address
1085 US ROUTE 4 E STE 2A, RUTLAND, VT 05701-8007
(802) 417-2067
Mailing address
1085 US-4 EAST, SUITE 2A, RUTLAND, VT 05701
(802) 417-2067
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
047.0123038
VT
103TC2200X
Clinical Child & Adolescent Psychologist
047.0123038
VT
Other
Enumeration date
04/13/2013
Last updated
06/17/2020
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