Provider Demographics
NPI:1518688472
Name:KOULA, GABRIELLA SIOUX (SLP-CF)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:SIOUX
Last Name:KOULA
Suffix:
Gender:F
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SALINA AVE APT 28
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-6952
Mailing Address - Country:US
Mailing Address - Phone:407-864-2279
Mailing Address - Fax:
Practice Address - Street 1:1201 US 1 STE 210
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3547
Practice Address - Country:US
Practice Address - Phone:561-776-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ10960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist