Healthcare Provider Details

I. General information

NPI: 1689199051
Provider Name (Legal Business Name): RENE MARIE GAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 08/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 W MAIN ST
ST CHARLES IL
60175-1010
US

IV. Provider business mailing address

1480 MONARCH CIR
NAPERVILLE IL
60564-9309
US

V. Phone/Fax

Practice location:
  • Phone: 630-513-5012
  • Fax: 630-513-1980
Mailing address:
  • Phone: 630-820-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number147000263
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: