Provider Demographics
NPI:1063757128
Name:GAUDREAULT, SUZANNE (MD, MS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GAUDREAULT
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4400
Mailing Address - Country:US
Mailing Address - Phone:253-274-4600
Mailing Address - Fax:253-274-4601
Practice Address - Street 1:950 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4400
Practice Address - Country:US
Practice Address - Phone:253-274-4600
Practice Address - Fax:253-274-4601
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60417743207QH0002X
OH35.085390207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine