Provider Demographics
NPI:1023669454
Name:LAYMAN, GWENDOLYN (MS CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:LAYMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:GWENDOLY N
Other - Middle Name:
Other - Last Name:BOLHUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP/L
Mailing Address - Street 1:10004 S 53RD AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3812
Mailing Address - Country:US
Mailing Address - Phone:708-289-9142
Mailing Address - Fax:
Practice Address - Street 1:7600 MASON AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-1297
Practice Address - Country:US
Practice Address - Phone:708-496-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty