MEDICARE: RENE MARIE GAY

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	237600000X	Audiologist-Hearing Aid Fitter	147000263	IL

General Provider Information

NPI Number	:	1689199051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE MARIE GAY

Provider Business Mailing Address
First Line	:	1480 MONARCH CIR
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-9309
Country	:	US
Telephone Number	:	630-820-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	2422 W MAIN ST
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60175-1010
Country	:	US
Telephone Number	:	630-513-5012
Fax Number	:	630-513-1980

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

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	08/07/2017

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