Healthcare Provider Details

I. General information

NPI: 1396653416
Provider Name (Legal Business Name): MADELINE GAUTREAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5175 EMERALD PKWY
DUBLIN OH
43017-1063
US

IV. Provider business mailing address

1180 CHAMBERS RD APT 124B
COLUMBUS OH
43212-1760
US

V. Phone/Fax

Practice location:
  • Phone: 614-764-5913
  • Fax:
Mailing address:
  • Phone: 614-736-3729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: