Provider Demographics
NPI:1629491386
Name:GAMBRILL, CAITLYN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:GAMBRILL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10723 HAMPTON MILL TER
Mailing Address - Street 2:#120
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-5457
Mailing Address - Country:US
Mailing Address - Phone:301-452-6759
Mailing Address - Fax:
Practice Address - Street 1:6801 DOUGLAS LEGUM DR
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6273
Practice Address - Country:US
Practice Address - Phone:301-452-6759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07065235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist