Healthcare Provider Details

I. General information

NPI: 1538080049
Provider Name (Legal Business Name): JESSICA LYNN GAUTHIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S CRAPO ST STE 100
MOUNT PLEASANT MI
48858-2941
US

IV. Provider business mailing address

10260 N SHEPHERD RD
CLARE MI
48617-9110
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-5938
  • Fax: 989-773-1968
Mailing address:
  • Phone: 989-330-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: