Provider Demographics
NPI:1457839235
Name:REYNOLDS, GWENDOLYN YVONNE (LSW)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:YVONNE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2563
Mailing Address - Country:US
Mailing Address - Phone:937-259-8805
Mailing Address - Fax:937-523-0729
Practice Address - Street 1:6929 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2563
Practice Address - Country:US
Practice Address - Phone:937-259-8805
Practice Address - Fax:937-523-0729
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health