Provider Demographics
NPI:1750505319
Name:MCMAHAN, GWENDOLYN LYNCH (SLP)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:LYNCH
Last Name:MCMAHAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16105 73RD TERRACE NORTH
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7475
Mailing Address - Country:US
Mailing Address - Phone:561-747-1153
Mailing Address - Fax:
Practice Address - Street 1:16105 73RD TER N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418-7475
Practice Address - Country:US
Practice Address - Phone:561-747-1153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist