Provider Demographics
NPI:1104395805
Name:GIBSON, LORETTA LYNCH (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:LYNCH
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 35TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3114
Mailing Address - Country:US
Mailing Address - Phone:202-320-7219
Mailing Address - Fax:
Practice Address - Street 1:3514 35TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3114
Practice Address - Country:US
Practice Address - Phone:202-320-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSLP000781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist