Provider Demographics
NPI:1588814370
Name:GAUDETTE, SHARI ILENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARI
Middle Name:ILENE
Last Name:GAUDETTE
Suffix:
Gender:F
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:800 MARSHALL ST
Mailing Address - Street 2:SLOT 512-21, DEPARTMENT OF PEDIATRIC PSYCHOLOGY
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3510
Mailing Address - Country:US
Mailing Address - Phone:501-364-1021
Mailing Address - Fax:501-363-1095
Practice Address - Street 1:800 MARSHALL ST
Practice Address - Street 2:SLOT 512-21, DEPARTMENT OF PEDIATRIC PSYCHOLOGY
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3510
Practice Address - Country:US
Practice Address - Phone:501-364-1021
Practice Address - Fax:501-363-1095
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR08-16P103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist