Provider Demographics
NPI:1518996982
Name:GATES, CAPUCINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAPUCINE
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 POINT VIEW CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7342
Mailing Address - Country:US
Mailing Address - Phone:910-686-4753
Mailing Address - Fax:
Practice Address - Street 1:3311 BURNT MILL DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2654
Practice Address - Country:US
Practice Address - Phone:910-251-5817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5273235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist