Provider Demographics
NPI:1396969523
Name:GILBERT, DENISE SHIDAL (MS,SLP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:SHIDAL
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MS,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4846
Mailing Address - Country:US
Mailing Address - Phone:270-556-3684
Mailing Address - Fax:270-201-2886
Practice Address - Street 1:210 AUDUBON DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4846
Practice Address - Country:US
Practice Address - Phone:270-556-3684
Practice Address - Fax:270-210-2886
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0663235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist