Provider Demographics
NPI:1124595459
Name:GIBLER, ALECIA (MHS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:GIBLER
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:
Other - Last Name:MITAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11736 GILLETTE ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3505
Mailing Address - Country:US
Mailing Address - Phone:573-230-0414
Mailing Address - Fax:
Practice Address - Street 1:1105 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6452
Practice Address - Country:US
Practice Address - Phone:573-659-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018024306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist