Provider Demographics
NPI:1205007226
Name:GAUTHIER, MICHELINE (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:MICHELINE
Middle Name:
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 RESERVOIR AVE
Mailing Address - Street 2:SUITE 305B
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6068
Mailing Address - Country:US
Mailing Address - Phone:401-942-8080
Mailing Address - Fax:401-942-3666
Practice Address - Street 1:1150 RESERVOIR AVE
Practice Address - Street 2:SUITE 305B
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6068
Practice Address - Country:US
Practice Address - Phone:401-942-8080
Practice Address - Fax:401-942-3666
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAUD000181231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist