Individual
IVIE MICHELLE GAUDETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1570 WILMINGTON DR STE 220, DUPONT, WA 98327-8773
(206) 453-4882
Mailing address
3213 W WHEELER ST # 302, SEATTLE, WA 98199-3245
(206) 453-4882
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-101832
WA
Other
Enumeration date
11/04/2019
Last updated
11/04/2019
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