Provider Demographics
NPI:1346017100
Name:GWYNNE, COURTNEY ELISABETH (MS, CGC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELISABETH
Last Name:GWYNNE
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ELISABETH
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 CAMBRIDGE ST FL 5
Mailing Address - Street 2:5.814
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2790
Mailing Address - Country:US
Mailing Address - Phone:617-724-3184
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST STE 5B
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-3184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC10037170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS