Provider Demographics
NPI:1679907596
Name:GAUSDEN, VIRGINIA B (MS)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:B
Last Name:GAUSDEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14605 E LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2105
Mailing Address - Country:US
Mailing Address - Phone:480-353-9975
Mailing Address - Fax:
Practice Address - Street 1:14605 E LARKSPUR DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2105
Practice Address - Country:US
Practice Address - Phone:480-353-9975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP8312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist