Provider Demographics
NPI:1518557768
Name:DORSEY, GWENDOLYN MAE A (MAED, CF-SLP)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN MAE
Middle Name:A
Last Name:DORSEY
Suffix:
Gender:F
Credentials:MAED, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S ENOTA DR NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2548
Mailing Address - Country:US
Mailing Address - Phone:678-865-4947
Mailing Address - Fax:
Practice Address - Street 1:428 S ENOTA DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2548
Practice Address - Country:US
Practice Address - Phone:678-865-4947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist