Provider Demographics
NPI:1710116470
Name:SMALLWOOD, GRETCHEN ROBINSON (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:ROBINSON
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 NEW ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-4033
Mailing Address - Country:US
Mailing Address - Phone:336-285-6791
Mailing Address - Fax:
Practice Address - Street 1:2415 NEW ORLEANS ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-4033
Practice Address - Country:US
Practice Address - Phone:336-285-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6027235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist