Healthcare Provider Details

I. General information

NPI: 1275326712
Provider Name (Legal Business Name): GABRIELLE BEAUDOIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N HORSESHOE TRL
SILT CO
81652-9832
US

IV. Provider business mailing address

3025 COAL MINE AVE APT 5C
RIFLE CO
81650-3922
US

V. Phone/Fax

Practice location:
  • Phone: 970-876-5700
  • Fax:
Mailing address:
  • Phone: 207-500-8146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: