Provider Demographics
NPI:1942528500
Name:PETURIS, GAYLAN CILLO (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GAYLAN
Middle Name:CILLO
Last Name:PETURIS
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 1:8909 RAND AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9126
Mailing Address - Country:US
Mailing Address - Phone:251-210-1632
Mailing Address - Fax:251-625-3152
Practice Address - Street 1:8909 RAND AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9126
Practice Address - Country:US
Practice Address - Phone:251-210-1632
Practice Address - Fax:251-625-3152
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2554235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist