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General NPI Number Information
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NPI Number | 1992520944
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Entity Type | Organization
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Legal Business Name | GRACIOUS WORDS SPEECH AND LANGUAGE THERAPY, LLC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 7151 RIVERVIEW ST
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City | NAVARRE
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State | FL
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Zip | 32566-6614
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Country | US
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Telephone | 505-803-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 RHONDA RD
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City | PACE
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State | FL
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Zip | 32571-2849
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Country | US
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Telephone | 505-803-7546
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY TAYLOR GWIN
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Credential | M.S. CCC-SLP
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Telephone | 505-803-7546
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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 |
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License Number State |
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