Provider Demographics
NPI:1760657464
Name:CLEVELAND, GLORIA (AU D)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 22ND ST
Mailing Address - Street 2:STE 100
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1107
Mailing Address - Country:US
Mailing Address - Phone:806-792-5331
Mailing Address - Fax:806-792-9417
Practice Address - Street 1:3621 22ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1301
Practice Address - Country:US
Practice Address - Phone:806-792-5331
Practice Address - Fax:806-792-9417
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51034231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L6768Medicare PIN