Provider Demographics
NPI:1679759443
Name:GILBERT, MARCIA LYNN (AUD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNN
Last Name:GILBERT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:LYNN
Other - Last Name:BOWMAN-GILBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:100 SCHUYLKILL MEDICAL PLZ
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3663
Mailing Address - Country:US
Mailing Address - Phone:570-621-5005
Mailing Address - Fax:570-628-2525
Practice Address - Street 1:100 SCHUYLKILL MEDICAL PLZ
Practice Address - Street 2:SUITE 203
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3663
Practice Address - Country:US
Practice Address - Phone:570-621-5005
Practice Address - Fax:570-628-2525
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006037231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA123312Medicare PIN