Provider Demographics
NPI:1720335052
Name:WALTER, GAIL LYNN (MS, SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:LYNN
Last Name:WALTER
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:LYNN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP-CCC
Mailing Address - Street 1:4555 SHOWDOW ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-2807
Mailing Address - Country:US
Mailing Address - Phone:321-626-7777
Mailing Address - Fax:
Practice Address - Street 1:4555 SHOWDOW ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-2807
Practice Address - Country:US
Practice Address - Phone:321-626-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ5682235Z00000X
FLSA12232235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist