Provider Demographics
NPI:1598886913
Name:GIBSON, BLINDA ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BLINDA
Middle Name:ANN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 BALLAD TREE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5760
Mailing Address - Country:US
Mailing Address - Phone:361-522-5300
Mailing Address - Fax:
Practice Address - Street 1:4205 WILDCAT DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5108
Practice Address - Country:US
Practice Address - Phone:361-242-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102287OtherTDLR
TX1815938Medicaid