Provider Demographics
NPI:1215069851
Name:AYLIFFE, GWEN HYATT (MS)
Entity type:Individual
Prefix:MS
First Name:GWEN
Middle Name:HYATT
Last Name:AYLIFFE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7445 AUBURN OAKS CT
Mailing Address - Street 2:SUITE 0
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-1386
Mailing Address - Country:US
Mailing Address - Phone:530-886-2860
Mailing Address - Fax:530-889-6735
Practice Address - Street 1:11716 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3732
Practice Address - Country:US
Practice Address - Phone:530-886-2860
Practice Address - Fax:530-889-6735
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health