| Organization Name: | MARY JEAN SADLAK PHD PC |
| NPI Number: | 1013301324 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY JEAN SADLAK (OWNER) |
| Mailing Address: | 160 Benmont Ave Suite 20 Bennington |
| State: | VT US |
| Postal Code: | 052011873 |
| Phone Number: | 8024423520 |
| Fax Number: | 8024473392 |
| NPI Enumeration Date: | 03/25/2015 |
| NPI Last Update Date: | 12/23/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 048.0000505 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |