Provider Demographics
NPI:1801545223
Name:GEWANDTER, KATHLEEN (MGC, LCGC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:GEWANDTER
Suffix:
Gender:F
Credentials:MGC, LCGC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10920 N MCKINLEY DRIVE
Mailing Address - Street 2:MKC-GEN
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:813-745-1760
Mailing Address - Fax:
Practice Address - Street 1:10920 MCKINLEY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6471
Practice Address - Country:US
Practice Address - Phone:813-745-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLGC88170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS