Provider Demographics
NPI:1982414686
Name:BLOOMING WISDOM PSYCHIATRY, PLLC
Entity type:Organization
Organization Name:BLOOMING WISDOM PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-490-9235
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-0085
Mailing Address - Country:US
Mailing Address - Phone:802-221-3313
Mailing Address - Fax:802-209-3507
Practice Address - Street 1:789 ETHAN ALLEN HWY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-9797
Practice Address - Country:US
Practice Address - Phone:802-221-3313
Practice Address - Fax:802-209-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty