Provider Demographics
NPI:1750524336
Name:DONOHUE, JENNIFER M (MA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:VT
Mailing Address - Zip Code:05652-0021
Mailing Address - Country:US
Mailing Address - Phone:802-793-2562
Mailing Address - Fax:
Practice Address - Street 1:355 AUTUMN POND WAY UNIT 201
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-4147
Practice Address - Country:US
Practice Address - Phone:802-793-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0045508101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health