Provider Demographics
NPI:1073591723
Name:GAUTEREAUX, ELIZABETH A (MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GAUTEREAUX
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6274
Mailing Address - Country:US
Mailing Address - Phone:480-558-5306
Mailing Address - Fax:480-558-5307
Practice Address - Street 1:225 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6274
Practice Address - Country:US
Practice Address - Phone:480-558-5306
Practice Address - Fax:480-558-5307
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-175231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDA7570OtherARIZONA DEPARTMENT OF HEALTH SERVICES
NV100507418Medicaid
NV100507418Medicaid
NVWQBHV101667Medicare ID - Type Unspecified