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General NPI Number Information
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NPI Number | 1235643024
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Entity Type | Individual
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Provider Name | COURTNI GONDREAU LA.C
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Gender | Female
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 5230 E SHEA BLVD FL 1
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5750
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Country | US
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Telephone | 480-876-9409
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Fax |
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Provider Business Mailing Address
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Address Line | 310 S. JEFFERSON ST.
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City | ST. CROIX FALLS
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State | WI
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Zip | 54024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1804
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | LAC-011382
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License Number State | AZ
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