Individual
GWYNETH DEVENDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2400 SE FEDERAL HWY STE 220, STUART, FL 34994-4556
(954) 934-2699
Mailing address
5397 AVOCADO BLVD, WEST PALM BEACH, FL 33411-8313
(570) 267-4125
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225378870
ABA THERAPY SOLUTIONS, LLC
FL
Enumeration date
06/26/2018
Last updated
06/26/2018
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