Healthcare Provider Details

I. General information

NPI: 1306757828
Provider Name (Legal Business Name): LAURA RHEAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 N PALM AVE
FRESNO CA
93704-1983
US

IV. Provider business mailing address

5445 N PALM AVE
FRESNO CA
93704-1941
US

V. Phone/Fax

Practice location:
  • Phone: 559-451-4388
  • Fax:
Mailing address:
  • Phone: 559-451-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: