Provider Demographics
NPI:1972069516
Name:GATES, JOELLA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOELLA
Middle Name:
Last Name:GATES
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 1:20206 ALTAI TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-1408
Mailing Address - Country:US
Mailing Address - Phone:281-222-9664
Mailing Address - Fax:
Practice Address - Street 1:20206 ALTAI TERRACE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-1408
Practice Address - Country:US
Practice Address - Phone:281-222-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102167235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist