Provider Demographics
NPI:1528184983
Name:BUCKLEY, GLORIA L (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:L
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 ABRAMS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2607
Mailing Address - Country:US
Mailing Address - Phone:214-827-1900
Mailing Address - Fax:214-821-8106
Practice Address - Street 1:4130 ABRAMS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2607
Practice Address - Country:US
Practice Address - Phone:214-827-1900
Practice Address - Fax:214-821-8106
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50332231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204082382OtherTAX ID #