Provider Demographics
NPI:1952636284
Name:GILLIAM, TORI JO (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:JO
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WILLIS RD SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-1652
Mailing Address - Country:US
Mailing Address - Phone:256-679-4971
Mailing Address - Fax:
Practice Address - Street 1:2000 WILLIS RD SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-1652
Practice Address - Country:US
Practice Address - Phone:256-679-4971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2048235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist