Provider Demographics
NPI:1306196498
Name:GILLANI, ANITA S (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:S
Last Name:GILLANI
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 FRANKFORD RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6834
Mailing Address - Country:US
Mailing Address - Phone:972-232-8077
Mailing Address - Fax:
Practice Address - Street 1:8000 FRANKFORD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6834
Practice Address - Country:US
Practice Address - Phone:972-232-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107815235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist