Provider Demographics
NPI:1760611982
Name:HAMPTON, GWYN (MA SLP)
Entity Type:Individual
Prefix:MRS
First Name:GWYN
Middle Name:
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:GREENVIEW
Mailing Address - State:CA
Mailing Address - Zip Code:96037-0243
Mailing Address - Country:US
Mailing Address - Phone:530-598-2008
Mailing Address - Fax:
Practice Address - Street 1:1217 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3459
Practice Address - Country:US
Practice Address - Phone:530-598-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP8653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist