Provider Demographics
NPI:1336694389
Name:GUMMERSALL, DAWN
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:GUMMERSALL
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 1:5192 W BRIDLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3934
Mailing Address - Country:US
Mailing Address - Phone:801-652-0101
Mailing Address - Fax:
Practice Address - Street 1:5192 W BRIDLE CREEK DR
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-3934
Practice Address - Country:US
Practice Address - Phone:801-652-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT320820-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist