Provider Demographics
NPI:1023375466
Name:CREEK, GWYN ACOSTA
Entity Type:Individual
Prefix:MRS
First Name:GWYN
Middle Name:ACOSTA
Last Name:CREEK
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 1:529 BRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-4453
Mailing Address - Country:US
Mailing Address - Phone:337-989-1849
Mailing Address - Fax:
Practice Address - Street 1:529 BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-4453
Practice Address - Country:US
Practice Address - Phone:337-989-1849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist