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Individual

MS. DEIDRA AUBREY GWYTHER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
175 W B ST STE I, SPRINGFIELD, OR 97477-4575
(541) 988-1025
(541) 844-1051
Mailing address
175 W B ST STE I, SPRINGFIELD, OR 97477-4575
(541) 988-1025
(541) 844-1051

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
106S00000X
Behavior Technician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
241382
OR
Enumeration date
05/22/2008
Last updated
11/04/2019
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