Provider Demographics
NPI:1376933697
Name:GANDOLFO-MULLER, MICHELE LYNN (ABA THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LYNN
Last Name:GANDOLFO-MULLER
Suffix:
Gender:F
Credentials:ABA THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70342 6TH ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5486
Mailing Address - Country:US
Mailing Address - Phone:504-214-5552
Mailing Address - Fax:
Practice Address - Street 1:70342 6TH ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5486
Practice Address - Country:US
Practice Address - Phone:504-214-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst