Provider Demographics
NPI:1386628659
Name:GILMORE, SUE A (MS / SLP)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:A
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MS / SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 N VIRGINIA ST
Mailing Address - Street 2:MAIL STOP 152 REDFIELD MEDICAL BUILDING
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89557-0152
Mailing Address - Country:US
Mailing Address - Phone:775-784-4887
Mailing Address - Fax:775-784-4095
Practice Address - Street 1:1664 N VIRGINIA ST
Practice Address - Street 2:MAIL STOP 152 REDFIELD MEDICAL BUILDING
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-0152
Practice Address - Country:US
Practice Address - Phone:775-784-4887
Practice Address - Fax:775-784-4095
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP26235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507280Medicaid