Provider Demographics
NPI:1043542970
Name:MARTIN, GWENDOLYN (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14074 TRADE CENTER DR
Mailing Address - Street 2:SUITE 134
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4563
Mailing Address - Country:US
Mailing Address - Phone:317-966-1987
Mailing Address - Fax:
Practice Address - Street 1:14074 TRADE CENTER DR
Practice Address - Street 2:SUITE 134
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4563
Practice Address - Country:US
Practice Address - Phone:317-966-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst