MEDICARE: GWYNN E DAVIES MA, CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00307000	NJ

General Provider Information

NPI Number	:	1083804710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWYNN E DAVIES MA, CCC/SLP

Provider Business Mailing Address
First Line	:	3525 QUAKERBRIDGE RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-1266
Country	:	US
Telephone Number	:	609-631-2840
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 QUAKERBRIDGE RD
Second Line	:
City	:	HAMILTON
State	:	NJ
Zip	:	08619-1266
Country	:	US
Telephone Number	:	609-631-2840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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