Provider Demographics
NPI:1447546312
Name:FOWLER-BERKEN, GWEN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:
Last Name:FOWLER-BERKEN
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 1:310 TERRELL RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-8765
Mailing Address - Country:US
Mailing Address - Phone:828-371-3940
Mailing Address - Fax:828-369-7497
Practice Address - Street 1:310 TERRELL RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734
Practice Address - Country:US
Practice Address - Phone:828-371-3940
Practice Address - Fax:828-369-7497
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist