Provider Demographics
NPI:1982040507
Name:GAUDETTE, PAUL RONALD (CADC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RONALD
Last Name:GAUDETTE
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 JUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-5642
Mailing Address - Country:US
Mailing Address - Phone:702-399-2769
Mailing Address - Fax:702-399-0271
Practice Address - Street 1:211 JUDSON AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-5642
Practice Address - Country:US
Practice Address - Phone:702-399-2769
Practice Address - Fax:702-399-0271
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV167101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)