Provider Demographics
NPI:1467182436
Name:RUBY, GABRIELLE ELVIRA
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ELVIRA
Last Name:RUBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 N PARKSIDE DR APT 301
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-3163
Mailing Address - Country:US
Mailing Address - Phone:630-995-2553
Mailing Address - Fax:
Practice Address - Street 1:15810 S 42ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7409
Practice Address - Country:US
Practice Address - Phone:480-759-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist