MEDICARE: MRS. GWENDOLYN MARIE TORGERSON M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	LL00003353	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386718955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GWENDOLYN MARIE TORGERSON M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2323 STEAMBOAT LOOP E
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-4833
Country	:	US
Telephone Number	:	360-769-7421
Fax Number	:	360-895-0203

Provider Business Practice Location Address
First Line	:	1008 BETHEL AVE STE E
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-4236
Country	:	US
Telephone Number	:	360-871-2076
Fax Number	:	360-895-0203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/09/2007

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Directions to “ MRS. GWENDOLYN MARIE TORGERSON M.S. CCC-SLP” Practice Location

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