Provider Demographics
NPI:1003537309
Name:SCOTT, GABRIELLE I (SLP)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:I
Last Name:SCOTT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-6549
Mailing Address - Country:US
Mailing Address - Phone:228-217-0538
Mailing Address - Fax:
Practice Address - Street 1:1620 HIGHWAY 11 N STE C
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2070
Practice Address - Country:US
Practice Address - Phone:769-242-2626
Practice Address - Fax:769-242-2685
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS-4851235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist