Provider Demographics
NPI:1699252486
Name:AUDETTE, ERIN ALEXANDER
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:ALEXANDER
Last Name:AUDETTE
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 1:1034 MITSCHER DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-7020
Mailing Address - Country:US
Mailing Address - Phone:586-703-0556
Mailing Address - Fax:
Practice Address - Street 1:5901 COLLEGE RD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4315
Practice Address - Country:US
Practice Address - Phone:586-703-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician