Provider Demographics
NPI:1003115080
Name:GAUL, ROXANE (MA CCCSP)
Entity Type:Individual
Prefix:MRS
First Name:ROXANE
Middle Name:
Last Name:GAUL
Suffix:
Gender:F
Credentials:MA CCCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9S324 WOODCREEK PL
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4573
Mailing Address - Country:US
Mailing Address - Phone:630-910-7816
Mailing Address - Fax:
Practice Address - Street 1:9S324 WOODCREEK PL
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-4573
Practice Address - Country:US
Practice Address - Phone:630-910-7816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.000020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist