Provider Demographics
NPI:1114574506
Name:SMITH, GWENDOLYN YVONNE
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:YVONNE
Last Name:SMITH
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 1:4750 15TH AVE NE APT 525
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4975
Mailing Address - Country:US
Mailing Address - Phone:206-739-9087
Mailing Address - Fax:
Practice Address - Street 1:316 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5325
Practice Address - Country:US
Practice Address - Phone:206-464-3923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor