Provider Demographics
NPI:1659882801
Name:GAUTHIER, EDOUARD A (BC-HIS)
Entity Type:Individual
Prefix:
First Name:EDOUARD
Middle Name:A
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:TED
Other - Middle Name:
Other - Last Name:GAUTHIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5927
Mailing Address - Country:US
Mailing Address - Phone:207-893-2930
Mailing Address - Fax:207-893-2939
Practice Address - Street 1:2 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5927
Practice Address - Country:US
Practice Address - Phone:207-893-2930
Practice Address - Fax:207-893-2939
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDL368237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist