Provider Demographics
NPI:1356109334
Name:LECLERC, GABRIELLA (HIS)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:LECLERC
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 NW VETERANS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-3936
Mailing Address - Country:US
Mailing Address - Phone:386-269-1079
Mailing Address - Fax:386-758-3101
Practice Address - Street 1:183 NW VETERANS ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-3936
Practice Address - Country:US
Practice Address - Phone:386-269-1079
Practice Address - Fax:386-758-3101
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5793237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist