Provider Demographics
NPI:1720577885
Name:GAUTREAUX, ELIZABETH AL
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:AL
Last Name:GAUTREAUX
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 1:12501 BROADWAY ST APT 5103
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7411
Mailing Address - Country:US
Mailing Address - Phone:337-281-8149
Mailing Address - Fax:
Practice Address - Street 1:900 LOVETT BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-3908
Practice Address - Country:US
Practice Address - Phone:832-786-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist