Provider Demographics
NPI:1538607239
Name:SLOBODNJAK, CORTNEY AMBER DONOHUE (LCMHC)
Entity type:Individual
Prefix:MRS
First Name:CORTNEY
Middle Name:AMBER DONOHUE
Last Name:SLOBODNJAK
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05143-0346
Mailing Address - Country:US
Mailing Address - Phone:802-558-1989
Mailing Address - Fax:
Practice Address - Street 1:14 MAIN ST.
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VT
Practice Address - Zip Code:05143
Practice Address - Country:US
Practice Address - Phone:802-558-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0112799101YM0800X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool