Provider Demographics
NPI:1619005808
Name:HAYWOOD, GRETCHEN LYN (AUD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LYN
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 5TH ST BLDG 675
Mailing Address - Street 2:
Mailing Address - City:WRIGHT PATTERSON AFB
Mailing Address - State:OH
Mailing Address - Zip Code:45433-7505
Mailing Address - Country:US
Mailing Address - Phone:708-724-2644
Mailing Address - Fax:
Practice Address - Street 1:2325 5TH ST BLDG 675
Practice Address - Street 2:
Practice Address - City:WRIGHT PATTERSON AFB
Practice Address - State:OH
Practice Address - Zip Code:45433-7505
Practice Address - Country:US
Practice Address - Phone:708-724-2644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6039639-4101231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist