1962536425 NPI number — GWEN ALYSON HINRICHS M.A., SLP

Table of content: GWEN ALYSON HINRICHS M.A., SLP (NPI 1962536425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962536425 NPI number — GWEN ALYSON HINRICHS M.A., SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HINRICHS
Provider First Name:
GWEN
Provider Middle Name:
ALYSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIFFIN
Provider Other First Name:
GWEN
Provider Other Middle Name:
ALYSON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962536425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 IMPERIAL DR UNIT 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOTA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34236-2453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-909-0111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 IMPERIAL DR
Provider Second Line Business Practice Location Address:
UNIT 108
Provider Business Practice Location Address City Name:
SARASOTA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-909-0111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SL004320L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA14673 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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