Provider Demographics
NPI:1326223611
Name:GAUT, SUNNY M (LMP)
Entity Type:Individual
Prefix:MS
First Name:SUNNY
Middle Name:M
Last Name:GAUT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 SW KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3719
Mailing Address - Country:US
Mailing Address - Phone:360-701-3642
Mailing Address - Fax:360-748-8651
Practice Address - Street 1:114 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4021
Practice Address - Country:US
Practice Address - Phone:360-701-3642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025123174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist