Individual
MRS. NICOLE GAUTHIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1815 E IRELAND RD, SOUTH BEND, IN 46614-2845
(574) 647-1700
(574) 647-7572
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-1840
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34008723A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300087542
—
IN
Enumeration date
01/18/2024
Last updated
04/02/2024
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