Provider Demographics
NPI:1033848825
Name:YOUNKIN, GWENDOLYN G
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:G
Last Name:YOUNKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ROLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-8753
Mailing Address - Country:US
Mailing Address - Phone:814-441-4556
Mailing Address - Fax:
Practice Address - Street 1:128 ROLAND DR
Practice Address - Street 2:
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870-8753
Practice Address - Country:US
Practice Address - Phone:814-441-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008203235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist