Provider Demographics
NPI:1083069488
Name:GWINN, MAKENZI (AUD)
Entity Type:Individual
Prefix:DR
First Name:MAKENZI
Middle Name:
Last Name:GWINN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 HOSPITAL WAY STE 115
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5175
Mailing Address - Country:US
Mailing Address - Phone:208-239-1960
Mailing Address - Fax:208-478-0076
Practice Address - Street 1:777 HOSPITAL WAY STE 115
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5175
Practice Address - Country:US
Practice Address - Phone:208-239-1960
Practice Address - Fax:208-478-0076
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist