Provider Demographics
NPI:1073680906
Name:GAUVIN, JACQUELINE (MS LLP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:GAUVIN
Suffix:
Gender:F
Credentials:MS LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9934 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-9467
Mailing Address - Country:US
Mailing Address - Phone:734-451-9798
Mailing Address - Fax:734-458-4614
Practice Address - Street 1:9934 5 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-9467
Practice Address - Country:US
Practice Address - Phone:734-451-9798
Practice Address - Fax:734-458-4614
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008459104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker