Provider Demographics
NPI:1154610632
Name:DUCLOS, VIRGINIA GAUDIO
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:GAUDIO
Last Name:DUCLOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-5900
Mailing Address - Country:US
Mailing Address - Phone:203-237-7546
Mailing Address - Fax:203-630-2021
Practice Address - Street 1:12 CURTIS ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5900
Practice Address - Country:US
Practice Address - Phone:203-237-7546
Practice Address - Fax:203-630-2021
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000170237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist