Provider Demographics
NPI:1235636861
Name:GOSSELIN, VANESSA RYAN
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RYAN
Last Name:GOSSELIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53525 HUNTERS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2091
Mailing Address - Country:US
Mailing Address - Phone:586-489-2100
Mailing Address - Fax:
Practice Address - Street 1:53525 HUNTERS CROSSING DR
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-2091
Practice Address - Country:US
Practice Address - Phone:586-489-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist