Provider Demographics
NPI:1205361920
Name:GILBERT, KATIE (AUD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WONDER WORLD DR
Mailing Address - Street 2:107
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7557
Mailing Address - Country:US
Mailing Address - Phone:512-667-7921
Mailing Address - Fax:
Practice Address - Street 1:1320 WONDER WORLD DR
Practice Address - Street 2:107
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7557
Practice Address - Country:US
Practice Address - Phone:512-667-7921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80860231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist