Healthcare Provider Details

I. General information

NPI: 1619133048
Provider Name (Legal Business Name): LOUISE P. GAUDREAU, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HARVARD CIR SUITE 109
WEST PALM BEACH FL
33409-1979
US

IV. Provider business mailing address

5 HARVARD CIR SUITE 109
WEST PALM BEACH FL
33409-1979
US

V. Phone/Fax

Practice location:
  • Phone: 561-242-1744
  • Fax: 561-688-9157
Mailing address:
  • Phone: 561-242-1744
  • Fax: 561-688-9157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY0005245
License Number StateFL

VIII. Authorized Official

Name: DR. LOUISE P. GAUDREAU
Title or Position: NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 561-242-1744