Provider Demographics
NPI:1386718955
Name:TORGERSON, GWENDOLYN MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:MARIE
Last Name:TORGERSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2323 STEAMBOAT LOOP E
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4833
Mailing Address - Country:US
Mailing Address - Phone:360-769-7421
Mailing Address - Fax:360-895-0203
Practice Address - Street 1:1008 BETHEL AVE STE E
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4236
Practice Address - Country:US
Practice Address - Phone:360-871-2076
Practice Address - Fax:360-895-0203
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8420614Medicaid