Provider Demographics
NPI:1477032506
Name:GIBBS, DAKOTA ALEXANDRIA (BS, MS,)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:ALEXANDRIA
Last Name:GIBBS
Suffix:
Gender:F
Credentials:BS, MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 ROBIN HILL LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5949
Mailing Address - Country:US
Mailing Address - Phone:972-369-2675
Mailing Address - Fax:
Practice Address - Street 1:3400 WATERVIEW PKWY STE 115
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1547
Practice Address - Country:US
Practice Address - Phone:972-369-2675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114582235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty