| Doctor Name: | TARA GWYNN |
| NPI Number: | 1043527609 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 10-025 |
| Business Practice Address: | 1900 Midland Trl Shelbyville, KY - 400658141 |
| Business Phone Number: | 5026331007 |
| Business Fax Number: | 5024370624 |
| Mailing Address: | 8922 Eli Dr, LOUISVILLE |
| State: | KY |
| Postal Code: | 402913189 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/02/2010 |
| NPI Last Update Date: | 07/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 10-025 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |