Provider Demographics
NPI:1629449202
Name:PINKSTON, GABRIELLE EXIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:EXIA
Last Name:PINKSTON
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 1:13771 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-3247
Mailing Address - Country:US
Mailing Address - Phone:918-733-2531
Mailing Address - Fax:
Practice Address - Street 1:7225 TWIN HILLS RD
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-2053
Practice Address - Country:US
Practice Address - Phone:918-733-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4220235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist