Provider Demographics
NPI:1336454248
Name:GILBERT, MARJORIE BRAE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:BRAE
Last Name:GILBERT
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 1:161 BROOKLAND CT
Mailing Address - Street 2:UNIT 8
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-6255
Mailing Address - Country:US
Mailing Address - Phone:540-931-3477
Mailing Address - Fax:
Practice Address - Street 1:3031 VALLEY AVE
Practice Address - Street 2:SUITE 105A
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2656
Practice Address - Country:US
Practice Address - Phone:540-722-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist