Provider Demographics
NPI:1760851166
Name:GAUDICHON, SUSAN (MA AUDIOLOGIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GAUDICHON
Suffix:
Gender:F
Credentials:MA AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 SETON CENTER PKWY
Mailing Address - Street 2:SUITE 215 - CREDENTIALING
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5290
Mailing Address - Country:US
Mailing Address - Phone:512-231-5507
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:6811 AUSTIN CENTER BOULEVARD SUITE 300
Practice Address - Street 2:ARC FAR WEST MEDICAL TOWER
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3166
Practice Address - Country:US
Practice Address - Phone:512-346-8888
Practice Address - Fax:512-406-7321
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX50859231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456686YKXVOtherMEDICARE TRAVIS COUNTY
TX456686YKXYOtherMEDICARE ROT
TX352791301Medicaid
TX352791302Medicaid