Active NPI
Jessica Willis, M.A.
- Clinical Psychologist
- Burlington, VT
National Provider Identifier
1861894727
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 047.0102268
- Practice address
- 35 King St
Suite 8
Burlington, VT 05401-4880 - Phone
- (802) 363-4311
- NPI assigned
- Sep 23, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 047.0102268 | VT | Primary |
Addresses
Primary practice location
35 King St
Suite 8
Burlington, VT 05401-4880
Mailing address
35 King St
Suite 8
Burlington, VT 05401-4880
Phone (802) 363-4311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023934 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047.0102268 | VT | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420848000000",
"number": "1861894727",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35 KING ST",
"address_2": "SUITE 8",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054014880",
"telephone_number": "802-363-4311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35 KING ST",
"address_2": "SUITE 8",
"city": "BURLINGTON",
"state": "VT",
"postal_code": "054014880",
"telephone_number": "802-363-4311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "JESSICA",
"credential": "M.A.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-23",
"last_updated": "2015-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VT",
"license": "047.0102268",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1023934",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.