Healthcare Provider Details

I. General information

NPI: 1417750134
Provider Name (Legal Business Name): GWENDYLAN ROWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 01/18/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 PATTERSON RD
DAYTON OH
45419-4336
US

IV. Provider business mailing address

948 PATTERSON RD
DAYTON OH
45419-4336
US

V. Phone/Fax

Practice location:
  • Phone: 614-412-1789
  • Fax:
Mailing address:
  • Phone: 614-412-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA185569
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA185569
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCDCA185569
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: