Healthcare Provider Details

I. General information

NPI: 1427964451
Provider Name (Legal Business Name): GILLIAN ELISE DIMONDE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 JAMES COMEAUX RD STE B
LAFAYETTE LA
70508-3376
US

IV. Provider business mailing address

110 MERLOT DR
OPELOUSAS LA
70570-0796
US

V. Phone/Fax

Practice location:
  • Phone: 185-583-2672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: