MEDICARE: MS. VIRGINIA B. GAUSDEN M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP8312	AZ

General Provider Information

NPI Number	:	1679907596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIRGINIA B. GAUSDEN M.S.

Provider Business Mailing Address
First Line	:	14605 E LARKSPUR DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-2105
Country	:	US
Telephone Number	:	480-353-9975
Fax Number	:

Provider Business Practice Location Address
First Line	:	14605 E LARKSPUR DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-2105
Country	:	US
Telephone Number	:	480-353-9975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2013
Last Update Date	:	08/27/2013

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Directions to “ MS. VIRGINIA B. GAUSDEN M.S.” Practice Location

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