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General NPI Number Information
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NPI Number | 1740717040
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Entity Type | Individual
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Provider Name | COREY GIBEAULT ENFANTO AUD
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Gender | Female
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Dates
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Enumeration Date | 05/17/2017
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | ELEANOR M. LUSE CENTER 489 MAIN STREET, POMEROY HALL
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City | BURLINGTON
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State | VT
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Zip | 05405
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Country | US
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Telephone | 802-656-0203
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Fax |
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Provider Business Mailing Address
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Address Line | 564 NOTCH RD
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City | MENDON
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State | VT
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Zip | 05701-6504
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Country | US
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Telephone | 802-558-8855
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State | VT
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