Provider Demographics
NPI:1639295835
Name:GIMLIN, CAROL L (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:L
Last Name:GIMLIN
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 E 78TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8550
Mailing Address - Country:US
Mailing Address - Phone:918-492-3349
Mailing Address - Fax:
Practice Address - Street 1:6225 E 78TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8550
Practice Address - Country:US
Practice Address - Phone:918-492-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist