Provider Demographics
NPI:1518488733
Name:BRYANT, GISELE PROBY
Entity Type:Individual
Prefix:MRS
First Name:GISELE
Middle Name:PROBY
Last Name:BRYANT
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 1:5635 S LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-4005
Mailing Address - Country:US
Mailing Address - Phone:318-780-7926
Mailing Address - Fax:
Practice Address - Street 1:6007 FINANCIAL PLZ STE 223
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-2657
Practice Address - Country:US
Practice Address - Phone:318-393-3636
Practice Address - Fax:318-688-7878
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1998235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist