Provider Demographics
NPI:1619303237
Name:KING, GABRIANA M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GABRIANA
Middle Name:M
Last Name:KING
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9325 MEADOWFIELD CT
Mailing Address - Street 2:J
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-2392
Mailing Address - Country:US
Mailing Address - Phone:336-340-2860
Mailing Address - Fax:804-658-3078
Practice Address - Street 1:9325 MEADOWFIELD CT
Practice Address - Street 2:J
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-2392
Practice Address - Country:US
Practice Address - Phone:336-340-2860
Practice Address - Fax:804-658-3078
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2202006375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist