Provider Demographics
NPI:1003556945
Name:JACK-JOHNSON, GILDA LETRICA (M ED CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:GILDA
Middle Name:LETRICA
Last Name:JACK-JOHNSON
Suffix:
Gender:F
Credentials:M ED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16910 GAFF COURT
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532
Mailing Address - Country:US
Mailing Address - Phone:832-622-4929
Mailing Address - Fax:
Practice Address - Street 1:16910 GAFF CT
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-4426
Practice Address - Country:US
Practice Address - Phone:832-622-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist