Healthcare Provider Details

I. General information

NPI: 1194611202
Provider Name (Legal Business Name): GABRIELLE ELIZA GWALTNEY AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12775 ESCANABA DR STE 3
DEWITT MI
48820-8615
US

IV. Provider business mailing address

8216 BURKSHIRE CIR APT 208
SWARTZ CREEK MI
48473-1836
US

V. Phone/Fax

Practice location:
  • Phone: 517-669-8080
  • Fax:
Mailing address:
  • Phone: 217-836-0968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601001212
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: