Provider Demographics
NPI:1417493123
Name:ABELE-STEPHENS, GABRIELLA GRACE (MS SLP)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:GRACE
Last Name:ABELE-STEPHENS
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:MS
Other - First Name:GABRIELLE
Other - Middle Name:GRACE
Other - Last Name:ABELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:175 SW FAIRWAY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3011
Mailing Address - Country:US
Mailing Address - Phone:772-267-0982
Mailing Address - Fax:
Practice Address - Street 1:175 SW FAIRWAY AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3011
Practice Address - Country:US
Practice Address - Phone:772-267-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ7955235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020614500Medicaid