Provider Demographics
NPI:1013123835
Name:GIRTH, GINA MICHELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MICHELLE
Last Name:GIRTH
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 1:227 W JEWELL DR
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-2209
Mailing Address - Country:US
Mailing Address - Phone:417-619-5037
Mailing Address - Fax:
Practice Address - Street 1:227 W JEWELL DR
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-2209
Practice Address - Country:US
Practice Address - Phone:417-619-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist