Provider Demographics
NPI:1578205753
Name:GIBSON, SABRINA ELIZABETH
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:ELIZABETH
Last Name:GIBSON
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 1:1389 JEFFERSON ST UNIT D508
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1851
Mailing Address - Country:US
Mailing Address - Phone:631-455-4099
Mailing Address - Fax:
Practice Address - Street 1:1389 JEFFERSON ST UNIT D508
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1851
Practice Address - Country:US
Practice Address - Phone:631-455-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist