Provider Demographics
NPI:1851532824
Name:GOUDREAU, YVONNE A (CAC-M)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:A
Last Name:GOUDREAU
Suffix:
Gender:F
Credentials:CAC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WA SEH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNACE
Mailing Address - State:MI
Mailing Address - Zip Code:49781-9490
Mailing Address - Country:US
Mailing Address - Phone:906-643-8689
Mailing Address - Fax:906-643-8671
Practice Address - Street 1:225 WA SEH ST
Practice Address - Street 2:
Practice Address - City:SAINT IGNACE
Practice Address - State:MI
Practice Address - Zip Code:49781-9490
Practice Address - Country:US
Practice Address - Phone:906-643-8689
Practice Address - Fax:906-643-8671
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)