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NPI Code Detail

MEDICARE: CHRISTINA GWYN SLP

MEDICARE:   CHRISTINA  GWYN  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
1235Z00000XSpeech-Language PathologistSA13576FL

General Provider Information

NPI Number : 1538789250
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA GWYN SLP
Provider Business Mailing Address
First Line : 954 NATHAN RIDGE RD
Second Line :
City : CLERMONT
State : FL
Zip : 34715-0022
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 490 S OLD WIRE RD
Second Line :
City : WILDWOOD
State : FL
Zip : 34785-5001
Country : US
Telephone Number : 352-748-3683
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2020
Last Update Date : 04/22/2020

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Directions to “ CHRISTINA GWYN SLP” Practice Location

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