Healthcare Provider Details

I. General information

NPI: 1588926679
Provider Name (Legal Business Name): GWENDOLYN MEIER EBERHARD SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GWENDOLYN MARIE MEIER SLP

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 E VILLA ST
PASADENA CA
91107-2433
US

IV. Provider business mailing address

4408 BRIGGS AVE
MONTROSE CA
91020-1110
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-2919
  • Fax: 626-449-2850
Mailing address:
  • Phone: 626-449-2919
  • Fax: 626-449-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: