Provider Demographics
NPI:1720516107
Name:WAINER, MARCELLE GUNDLACH (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARCELLE
Middle Name:GUNDLACH
Last Name:WAINER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:MARCELLE
Other - Last Name:GUNDLACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4224 HOUMA BLVD STE 640
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2939
Mailing Address - Country:US
Mailing Address - Phone:504-456-5120
Mailing Address - Fax:
Practice Address - Street 1:4224 HOUMA BLVD STE 640
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2939
Practice Address - Country:US
Practice Address - Phone:504-456-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist