Provider Demographics
NPI:1881802734
Name:GAUDREAU, LESA RENAE (BC-HIS)
Entity type:Individual
Prefix:MS
First Name:LESA
Middle Name:RENAE
Last Name:GAUDREAU
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:LESA
Other - Middle Name:R
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8764 EAST SHEA BOULEVARD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-443-9119
Mailing Address - Fax:480-443-9799
Practice Address - Street 1:8764 EAST SHEA BOULEVARD
Practice Address - Street 2:SUITE 115
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-443-9119
Practice Address - Fax:480-443-9799
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1979237700000X
AZHAD1979237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist