Provider Demographics
NPI:1730317884
Name:EIBAN, GLORIA DARLENE (MED)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:DARLENE
Last Name:EIBAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LONGWOOD CENTER FOR COMMUNICATION LITERACY &
Mailing Address - Street 2:102 HIGH STREET
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23909-0001
Mailing Address - Country:US
Mailing Address - Phone:434-395-2972
Mailing Address - Fax:
Practice Address - Street 1:LONGWOOD CENTER FOR COMMUNICATION LITERACY &
Practice Address - Street 2:102 HIGH STREET
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23909-0001
Practice Address - Country:US
Practice Address - Phone:434-395-2972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000730235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist