Provider Demographics
NPI:1447026034
Name:VANDERIET, GWENDOLYN (MA)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:VANDERIET
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15701 E 1ST AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9037
Mailing Address - Country:US
Mailing Address - Phone:303-326-1485
Mailing Address - Fax:
Practice Address - Street 1:15701 EAST 1ST AVENUE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-9037
Practice Address - Country:US
Practice Address - Phone:303-364-0947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist