Provider Demographics
NPI:1053622936
Name:BARTLETT, GAY LYNN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:GAY LYNN
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:GAY LYNN
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3122 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-4004
Mailing Address - Country:US
Mailing Address - Phone:937-299-9337
Mailing Address - Fax:937-299-9227
Practice Address - Street 1:3122 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4004
Practice Address - Country:US
Practice Address - Phone:937-299-9337
Practice Address - Fax:937-299-9227
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2367282Medicaid
OH2367282Medicaid