Provider Demographics
NPI:1164166633
Name:GILBERT, SENA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SENA
Middle Name:MARIE
Last Name:GILBERT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 IDITAROD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3640
Mailing Address - Country:US
Mailing Address - Phone:907-750-8225
Mailing Address - Fax:
Practice Address - Street 1:210 IDITAROD AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3640
Practice Address - Country:US
Practice Address - Phone:907-750-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKSLPS358235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist