Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003340951 |
---|---|
Provider Name | Denise R. Gaudette |
First Address | Springfield, OR 97477-0159 |
Second Address | Springfield, OR 97477-5470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2017 |
Last Update Date | 06/08/2021 |