Provider Demographics
NPI:1235460502
Name:GILBERT, JOELLEN (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 W 8TH ST
Mailing Address - Street 2:TOWER 1,4TH FL., ROOM 4509
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6533
Mailing Address - Country:US
Mailing Address - Phone:904-244-9057
Mailing Address - Fax:904-244-9616
Practice Address - Street 1:580 W 8TH ST
Practice Address - Street 2:TOWER 1,4TH FL., ROOM 4509
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6533
Practice Address - Country:US
Practice Address - Phone:904-244-9057
Practice Address - Fax:904-244-9616
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4505235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist