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General NPI Number Information
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NPI Number | 1780127373
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Entity Type | Individual
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Provider Name | SHANDA GWEN GAUNT MS CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 11091 JASEN AVE NE SUITE 2 COURAGE KENNY REHABILITATION INSTITUTE ALBERTVILLE PART
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City | ALBERTVILLE
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State | MN
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Zip | 55301
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Country | US
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Telephone | 763-744-4160
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Fax | 763-497-0679
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Provider Business Mailing Address
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Address Line | 5436 KAHLER DRIVE NE
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City | ALBERTVILLE
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State | MN
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Zip | 55301
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Country | US
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Telephone | 763-370-9860
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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 | 7438
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License Number State | MN
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