Provider Demographics
NPI:1164407110
Name:COUSINS, GAYLE ROGERS (MS FAAA)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ROGERS
Last Name:COUSINS
Suffix:
Gender:F
Credentials:MS FAAA
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:JEAN
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:318 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441-1691
Mailing Address - Country:US
Mailing Address - Phone:218-546-8375
Mailing Address - Fax:218-546-4400
Practice Address - Street 1:318 E MAIN ST
Practice Address - Street 2:CENTRAL LAKES MEDICAL CLINIC PA
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1691
Practice Address - Country:US
Practice Address - Phone:218-546-8375
Practice Address - Fax:218-546-4400
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5021231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist