Provider Demographics
NPI:1326119645
Name:GEBEL, MARY LANG (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LANG
Last Name:GEBEL
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 PARKWAY DR.
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792
Mailing Address - Country:US
Mailing Address - Phone:404-281-0920
Mailing Address - Fax:229-236-0519
Practice Address - Street 1:129 PARKWAY DR.
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792
Practice Address - Country:US
Practice Address - Phone:404-281-0920
Practice Address - Fax:229-236-0519
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005579235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA670007816AMedicaid