Provider Demographics
NPI:1871363390
Name:DESJARDINS, JEAN-PAUL
Entity type:Individual
Prefix:
First Name:JEAN-PAUL
Middle Name:
Last Name:DESJARDINS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JP
Other - Middle Name:
Other - Last Name:DESJARDINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:208 FLYNN AVE STE 3J
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5420
Mailing Address - Country:US
Mailing Address - Phone:802-488-6920
Mailing Address - Fax:802-488-6919
Practice Address - Street 1:1138 PINE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5353
Practice Address - Country:US
Practice Address - Phone:802-488-6000
Practice Address - Fax:802-488-6919
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0134908172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker