Provider Demographics
NPI:1164578076
Name:BOURGAULT, DANIELLE E (EDS, NCSP)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:E
Last Name:BOURGAULT
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 E ELLIOT RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-1304
Mailing Address - Country:US
Mailing Address - Phone:480-892-2801
Mailing Address - Fax:480-926-3673
Practice Address - Street 1:2550 E ELLIOT RD
Practice Address - Street 2:PSYC OFFICE
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1304
Practice Address - Country:US
Practice Address - Phone:480-892-2801
Practice Address - Fax:480-926-3673
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool