Provider Demographics
NPI:1942791819
Name:PINZONE, GWENDOLYN (MS ED,CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:PINZONE
Suffix:
Gender:F
Credentials:MS ED,CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 HENDRICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3308
Mailing Address - Country:US
Mailing Address - Phone:585-205-0469
Mailing Address - Fax:
Practice Address - Street 1:BLOOM CREATIVE ARTS AND THERAPY 3377 LAKE SHORE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14219
Practice Address - Country:US
Practice Address - Phone:716-422-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program