Provider Demographics
NPI:1184259954
Name:GERNALE, CELINA GRACE FABIE
Entity type:Individual
Prefix:
First Name:CELINA GRACE
Middle Name:FABIE
Last Name:GERNALE
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 1:7870 INDIAN BLANKET
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8563
Mailing Address - Country:US
Mailing Address - Phone:409-656-7604
Mailing Address - Fax:
Practice Address - Street 1:17200 STATE HIGHWAY 249
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1184
Practice Address - Country:US
Practice Address - Phone:281-664-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116565235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist