Provider Demographics
NPI:1053465377
Name:GNEWIKOW, DAVID W (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:GNEWIKOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 LAUREL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8406
Mailing Address - Country:US
Mailing Address - Phone:615-758-4901
Mailing Address - Fax:
Practice Address - Street 1:1002 PLEASANT GROVE PL STE C
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-1501
Practice Address - Country:US
Practice Address - Phone:615-406-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1262231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist