Provider Demographics
NPI:1043334972
Name:GAUTHIER, NANETTE JOLIE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:NANETTE
Middle Name:JOLIE
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 HOLLY MOORE DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4536
Mailing Address - Country:US
Mailing Address - Phone:337-781-8419
Mailing Address - Fax:
Practice Address - Street 1:333 1ST ST N
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6945
Practice Address - Country:US
Practice Address - Phone:180-094-0503
Practice Address - Fax:188-879-4503
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist