Provider Demographics
NPI:1164611083
Name:GREEN GENTILE, LAURA E (AUD, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:E
Last Name:GREEN GENTILE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:E
Other - Last Name:GREEN GENTILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:1130 BEACHVIEW ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3700
Mailing Address - Country:US
Mailing Address - Phone:214-324-0418
Mailing Address - Fax:214-324-0693
Practice Address - Street 1:1130 BEACHVIEW ST
Practice Address - Street 2:SUITE 240
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3700
Practice Address - Country:US
Practice Address - Phone:214-324-0418
Practice Address - Fax:214-324-0693
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50934231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist