Provider Demographics
NPI:1962536425
Name:HINRICHS, GWEN ALYSON (MA, SLP)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:ALYSON
Last Name:HINRICHS
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:GWEN
Other - Middle Name:ALYSON
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1100 IMPERIAL DR UNIT 108
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-2453
Mailing Address - Country:US
Mailing Address - Phone:610-909-0111
Mailing Address - Fax:
Practice Address - Street 1:100 IMPERIAL DR
Practice Address - Street 2:UNIT 108
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236
Practice Address - Country:US
Practice Address - Phone:610-909-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004320L235Z00000X
FLSA14673235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist