Provider Demographics
NPI:1619738507
Name:GIBSON, BRITTANY RENEE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:RENEE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4429
Mailing Address - Country:US
Mailing Address - Phone:202-277-1357
Mailing Address - Fax:
Practice Address - Street 1:14601 LAMAR RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2918
Practice Address - Country:US
Practice Address - Phone:703-491-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2204001265246Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology