Provider Demographics
NPI:1710329602
Name:EDWARDS, GWENDOLYN L (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CONCORD HTS
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-2900
Mailing Address - Country:US
Mailing Address - Phone:864-490-1121
Mailing Address - Fax:
Practice Address - Street 1:107 CONCORD HTS
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2900
Practice Address - Country:US
Practice Address - Phone:864-490-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6926235Z00000X
SC1022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist