Healthcare Provider Details

I. General information

NPI: 1740717040
Provider Name (Legal Business Name): COREY GIBEAULT ENFANTO AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELEANOR M. LUSE CENTER 489 MAIN STREET, POMEROY HALL
BURLINGTON VT
05405
US

IV. Provider business mailing address

564 NOTCH RD
MENDON VT
05701-6504
US

V. Phone/Fax

Practice location:
  • Phone: 802-656-0203
  • Fax:
Mailing address:
  • Phone: 802-558-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: