Provider Demographics
NPI:1194611202
Name:GWALTNEY, GABRIELLE ELIZA (AUD)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ELIZA
Last Name:GWALTNEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8216 BURKSHIRE CIR APT 208
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1836
Mailing Address - Country:US
Mailing Address - Phone:217-836-0968
Mailing Address - Fax:
Practice Address - Street 1:12775 ESCANABA DR STE 3
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8615
Practice Address - Country:US
Practice Address - Phone:517-669-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601001212231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist