Individual
JACQUELYN LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, NCTMB, CCA
Contact information
Practice address
1193 ETHAN ALLEN HWY, FAIRFAX, VT 05454-5433
(802) 999-9985
(802) 524-9800
Mailing address
1193 ETHAN ALLEN HWY, FAIRFAX, VT 05454-5433
(802) 999-9985
(802) 524-9800
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
019608
NY
Other
Enumeration date
01/29/2010
Last updated
01/29/2010
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