Provider Demographics
NPI:1659015808
Name:EBERLE, GABRIELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:EBERLE
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 1:238 SANTA ANA WAY
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8102
Mailing Address - Country:US
Mailing Address - Phone:631-495-6084
Mailing Address - Fax:
Practice Address - Street 1:238 SANTA ANA WAY
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-8102
Practice Address - Country:US
Practice Address - Phone:631-495-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14306035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist