Provider Demographics
NPI:1154507069
Name:GILMORE, DEON (MSCCCSLP)
Entity Type:Individual
Prefix:MS
First Name:DEON
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 WYNTERCREST LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4515
Mailing Address - Country:US
Mailing Address - Phone:919-767-8348
Mailing Address - Fax:
Practice Address - Street 1:2632 WYNTERCREST LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4515
Practice Address - Country:US
Practice Address - Phone:919-767-8348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6720235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist