Provider Demographics
NPI:1407575558
Name:GENTRY, FELICIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:GENTRY
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 1:245 COUNTY ROAD 3581
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:TX
Mailing Address - Zip Code:76073-5013
Mailing Address - Country:US
Mailing Address - Phone:318-510-8995
Mailing Address - Fax:
Practice Address - Street 1:245 COUNTY ROAD 3581
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:TX
Practice Address - Zip Code:76073-5013
Practice Address - Country:US
Practice Address - Phone:318-510-8995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist