Provider Demographics
NPI:1104539204
Name:WIND RIVER THERAPY, LLC
Entity type:Organization
Organization Name:WIND RIVER THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARISI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-391-9073
Mailing Address - Street 1:PO BOX 9212
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05407-9212
Mailing Address - Country:US
Mailing Address - Phone:802-391-9073
Mailing Address - Fax:
Practice Address - Street 1:54 W TWIN OAKS TER STE 12
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7141
Practice Address - Country:US
Practice Address - Phone:802-391-9073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty