Provider Demographics
NPI:1720821739
Name:GALLAGHER, JANINE M
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 CADYS FALLS RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-9137
Mailing Address - Country:US
Mailing Address - Phone:802-888-5229
Mailing Address - Fax:802-888-5392
Practice Address - Street 1:480 CADYS FALLS RD
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-9137
Practice Address - Country:US
Practice Address - Phone:802-888-5229
Practice Address - Fax:802-888-5392
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1518044676Medicaid