Provider Demographics
NPI:1518524438
Name:GILLETT, NAOMI SHURE (MS, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:SHURE
Last Name:GILLETT
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 LAKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-9275
Mailing Address - Country:US
Mailing Address - Phone:479-420-6330
Mailing Address - Fax:
Practice Address - Street 1:1915 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2725
Practice Address - Country:US
Practice Address - Phone:479-966-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist