Provider Demographics
NPI:1023341146
Name:MCMAHAN, JEANNE E (MA)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:E
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:JEANNE
Other - Middle Name:E
Other - Last Name:DOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:SOUTH STRAFFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05070-0096
Mailing Address - Country:US
Mailing Address - Phone:802-765-4024
Mailing Address - Fax:
Practice Address - Street 1:32 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091-1122
Practice Address - Country:US
Practice Address - Phone:603-381-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000520101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health