Provider Demographics
NPI:1679975163
Name:CHAUDOIR, HEATHER (LICSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CHAUDOIR
Suffix:
Gender:F
Credentials:LICSW
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 11
Mailing Address - Street 2:
Mailing Address - City:SAXTONS RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05154-0011
Mailing Address - Country:US
Mailing Address - Phone:802-869-2747
Mailing Address - Fax:802-869-2746
Practice Address - Street 1:3 ACADEMY AVENUE
Practice Address - Street 2:
Practice Address - City:SAXTONS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05154
Practice Address - Country:US
Practice Address - Phone:802-869-2747
Practice Address - Fax:802-869-2746
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.01032551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1024123Medicaid
VT1024123Medicaid