Provider Demographics
NPI:1023159597
Name:GAUDREAU, LOUISE P (PHD)
Entity type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:P
Last Name:GAUDREAU
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:5 HARVARD CIR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1979
Mailing Address - Country:US
Mailing Address - Phone:561-242-1744
Mailing Address - Fax:561-688-9157
Practice Address - Street 1:5 HARVARD CIR
Practice Address - Street 2:SUITE 109
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1979
Practice Address - Country:US
Practice Address - Phone:561-242-1744
Practice Address - Fax:561-688-9157
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2008-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPY0005245103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59823Medicare PIN