Provider Demographics
NPI:1790406064
Name:GILL, CARA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:GILL
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 1:1505 MADRONA ST N STE 200
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8324
Mailing Address - Country:US
Mailing Address - Phone:208-933-2010
Mailing Address - Fax:208-933-2011
Practice Address - Street 1:1505 MADRONA ST N STE 200
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-8324
Practice Address - Country:US
Practice Address - Phone:208-933-2010
Practice Address - Fax:208-933-2011
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-5967235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist