Provider Demographics
NPI:1699103309
Name:FIELDS-PROCTOR, GWENDOLYN (MS,SLP)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:
Last Name:FIELDS-PROCTOR
Suffix:
Gender:F
Credentials:MS,SLP
Other - Prefix:MRS
Other - First Name:GWENDOLYN
Other - Middle Name:CONSTANCE
Other - Last Name:FIELDS-PROCTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1200 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:202-645-3188
Mailing Address - Fax:202-645-3190
Practice Address - Street 1:1200 1ST ST NE FL 9
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7953
Practice Address - Country:US
Practice Address - Phone:202-645-3188
Practice Address - Fax:202-645-3190
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist