Provider Demographics
NPI:1346396009
Name:GIBBS, JANELL MARIE (MHS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANELL
Middle Name:MARIE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 N KERN DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3823
Mailing Address - Country:US
Mailing Address - Phone:636-272-2580
Mailing Address - Fax:
Practice Address - Street 1:4140 OLD MILL PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6550
Practice Address - Country:US
Practice Address - Phone:636-926-2700
Practice Address - Fax:636-447-4919
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001010962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist