Provider Demographics
NPI:1073123477
Name:PISKE, GINA R (SLP)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:R
Last Name:PISKE
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 1:1112 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3931
Mailing Address - Country:US
Mailing Address - Phone:214-937-5350
Mailing Address - Fax:469-838-6488
Practice Address - Street 1:1112 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3931
Practice Address - Country:US
Practice Address - Phone:214-937-5350
Practice Address - Fax:469-838-6488
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15902235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist