Provider Demographics
NPI:1588926679
Name:EBERHARD, GWENDOLYN MEIER (SLP)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:MEIER
Last Name:EBERHARD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:MARIE
Other - Last Name:MEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:4408 BRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1110
Mailing Address - Country:US
Mailing Address - Phone:626-449-2919
Mailing Address - Fax:626-449-2850
Practice Address - Street 1:2088 E VILLA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2433
Practice Address - Country:US
Practice Address - Phone:626-449-2919
Practice Address - Fax:626-449-2850
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17312OtherSLP CALIFORNIA STATE LICENSE