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General NPI Number Information
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NPI Number | 1760293633
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Entity Type | Individual
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Provider Name | JERRICA GAUDREAU
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Gender | Female
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Dates
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Enumeration Date | 01/18/2025
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Last Update Date | 01/18/2025
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Provider Practice Location Address
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Address Line | 5 RIVER ST
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City | WINDSOR
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State | VT
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Zip | 05089-1445
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Country | US
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Telephone | 802-222-0817
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Fax |
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Provider Business Mailing Address
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Address Line | 257 TORY HILL RD
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City | LANGDON
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State | NH
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Zip | 03602-8237
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Country | US
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Telephone | 802-304-3391
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 164.0001795
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License Number State | VT
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