Provider Demographics
NPI:1366720609
Name:BOEDGES, REBECCA N (MS, MS, LCMHC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:N
Last Name:BOEDGES
Suffix:
Gender:F
Credentials:MS, MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHURCH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4451
Mailing Address - Country:US
Mailing Address - Phone:802-489-6701
Mailing Address - Fax:
Practice Address - Street 1:1 CHURCH ST FL 3
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4451
Practice Address - Country:US
Practice Address - Phone:802-489-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0069445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health