Provider Demographics
NPI:1134324023
Name:ENGEL, GWEN
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:ENGEL
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 1:2801 COHO ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4574
Mailing Address - Country:US
Mailing Address - Phone:608-273-3232
Mailing Address - Fax:608-273-3426
Practice Address - Street 1:2801 COHO ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4574
Practice Address - Country:US
Practice Address - Phone:608-273-3232
Practice Address - Fax:608-273-3426
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2478-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42795900Medicaid