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General NPI Number Information
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NPI Number | 1609034313
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Entity Type | Individual
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Provider Name | GINA WERMUTH M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 30 N SAN PEDRO RD STE. 265
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City | SAN RAFAEL
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State | CA
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Zip | 94903-4118
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Country | US
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Telephone | 415-479-7880
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Fax |
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Provider Business Mailing Address
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Address Line | 120 FLORIBEL AVE
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City | SAN ANSELMO
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State | CA
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Zip | 94960-2215
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Country | US
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Telephone | 831-818-2308
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 15847
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License Number State | CA
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