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NPI Code Detail

MEDICARE: MISS NANETTE JOLIE GAUTHIER MCD, CCC-SLP

MEDICARE: MISS NANETTE JOLIE GAUTHIER MCD, CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist4231LA

General Provider Information

NPI Number : 1043334972
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS NANETTE JOLIE GAUTHIER MCD, CCC-SLP
Provider Business Mailing Address
First Line : 521 HOLLY MOORE DR
Second Line :
City : PINEVILLE
State : LA
Zip : 71360-4536
Country : US
Telephone Number : 337-781-8419
Fax Number :
Provider Business Practice Location Address
First Line : 333 1ST ST N
Second Line : SUITE 200
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-6945
Country : US
Telephone Number : 180-094-0503
Fax Number : 188-879-4503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2007
Last Update Date : 07/08/2007

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Directions to “ MISS NANETTE JOLIE GAUTHIER MCD, CCC-SLP” Practice Location

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