Provider Demographics
NPI:1144344870
Name:EWASKIW-GORDON, LYNN ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:EWASKIW-GORDON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2413
Mailing Address - Country:US
Mailing Address - Phone:570-342-2686
Mailing Address - Fax:
Practice Address - Street 1:200 S MEADE ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6221
Practice Address - Country:US
Practice Address - Phone:570-823-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist