Provider Demographics
NPI:1205384054
Name:GIBSON, JEANNA (SLPA)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 SR 903
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-8995
Mailing Address - Country:US
Mailing Address - Phone:509-649-4729
Mailing Address - Fax:
Practice Address - Street 1:431 BROWN RD
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-8995
Practice Address - Country:US
Practice Address - Phone:509-306-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP606554232355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant