Provider Demographics
NPI:1659128627
Name:GAMMILL, GRACEN LEIGH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GRACEN
Middle Name:LEIGH
Last Name:GAMMILL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:GRACEN
Other - Middle Name:LEIGH
Other - Last Name:GAMMILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:815 BRENTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3020
Mailing Address - Country:US
Mailing Address - Phone:214-697-4439
Mailing Address - Fax:
Practice Address - Street 1:12890 HILLCREST RD STE K113
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1504
Practice Address - Country:US
Practice Address - Phone:214-681-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist