Provider Demographics
NPI:1326484924
Name:HALL, GWENDOLYN A (SPEECH THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11246 FIELDCREST DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-1824
Mailing Address - Country:US
Mailing Address - Phone:225-259-0058
Mailing Address - Fax:225-778-0403
Practice Address - Street 1:11246 FIELDCREST DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-1824
Practice Address - Country:US
Practice Address - Phone:225-259-0058
Practice Address - Fax:225-778-0403
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist