Provider Demographics
NPI:1851706105
Name:GAUDREAU, HOLLY BETH (ATC)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:BETH
Last Name:GAUDREAU
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 EAGANDALE PL APT 225
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1239
Mailing Address - Country:US
Mailing Address - Phone:612-366-2191
Mailing Address - Fax:
Practice Address - Street 1:8100 W 78TH ST.
Practice Address - Street 2:SUITE 225
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439
Practice Address - Country:US
Practice Address - Phone:952-946-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer