Individual
MALLORY GAUTHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
207 W JACKSON ST STE 201, CARBONDALE, IL 62901-1408
(618) 457-2963
(618) 457-2992
Mailing address
207 W JACKSON ST STE 201, CARBONDALE, IL 62901-1408
(618) 457-2963
(618) 457-2992
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006422
IL
Other
Enumeration date
10/26/2017
Last updated
04/20/2026
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