Provider Demographics
NPI:1801366406
Name:STOVALL, GINA (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:STOVALL
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7337 NORFOLK PL
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3611
Mailing Address - Country:US
Mailing Address - Phone:512-750-6467
Mailing Address - Fax:
Practice Address - Street 1:1100 CIRCLE DRIVE SUITE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119
Practice Address - Country:US
Practice Address - Phone:817-566-1100
Practice Address - Fax:817-536-6945
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0000785235Z00000X
TX1107103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
18-69273OtherBEHAVIOR ANALYST CERTIFICATION BOARD (BACB)