Provider Demographics
NPI:1083837652
Name:GIBSON, DEANDRA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEANDRA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 W CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5237
Mailing Address - Country:US
Mailing Address - Phone:501-305-3004
Mailing Address - Fax:
Practice Address - Street 1:304 S SOWELL ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6356
Practice Address - Country:US
Practice Address - Phone:501-268-9227
Practice Address - Fax:501-268-7734
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist