MEDICARE: GWEN VANDERBOSCH M.A., 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	453269	IN

General Provider Information

NPI Number	:	1427880483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWEN VANDERBOSCH M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	1420 WAYNEDALE DR
Second Line	:
City	:	GARRETT
State	:	IN
Zip	:	46738-2073
Country	:	US
Telephone Number	:	260-602-5887
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 E HOUSTON ST
Second Line	:
City	:	GARRETT
State	:	IN
Zip	:	46738-1662
Country	:	US
Telephone Number	:	260-357-3112
Fax Number	:

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

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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Directions to “ GWEN VANDERBOSCH M.A., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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