Provider Demographics
NPI:1134715840
Name:ST. GABRIEL SPEECH-LANGUAGE PATHOLOGY
Entity type:Organization
Organization Name:ST. GABRIEL SPEECH-LANGUAGE PATHOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SINES
Authorized Official - Suffix:
Authorized Official - Credentials:MCD CCC-SLP
Authorized Official - Phone:318-471-5671
Mailing Address - Street 1:1002 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5204
Mailing Address - Country:US
Mailing Address - Phone:318-471-5671
Mailing Address - Fax:
Practice Address - Street 1:1002 E 5TH ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5204
Practice Address - Country:US
Practice Address - Phone:318-471-5671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty