Provider Demographics
NPI:1053194183
Name:DORMUS PARRA, GABRIELA KARLA
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:KARLA
Last Name:DORMUS PARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 JEFFREY LN
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-7706
Mailing Address - Country:US
Mailing Address - Phone:423-503-2158
Mailing Address - Fax:
Practice Address - Street 1:2425 JEFFREY LN
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-7706
Practice Address - Country:US
Practice Address - Phone:423-503-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007732235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist