Provider Demographics
NPI:1669798138
Name:GILL, MARIE HERRERA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:HERRERA
Last Name:GILL
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 1:7618 LARCHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2811
Mailing Address - Country:US
Mailing Address - Phone:972-661-3301
Mailing Address - Fax:
Practice Address - Street 1:1112 N FLOYD RD
Practice Address - Street 2:SUITE 9
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4243
Practice Address - Country:US
Practice Address - Phone:972-470-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist