Provider Demographics
NPI:1740916006
Name:GIBSON, MAKAYLA ANNE
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:ANNE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14379 US-9W
Mailing Address - Street 2:
Mailing Address - City:RAVENA
Mailing Address - State:NY
Mailing Address - Zip Code:12143
Mailing Address - Country:US
Mailing Address - Phone:518-756-3124
Mailing Address - Fax:
Practice Address - Street 1:2 BETHLEHEM CT
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1306
Practice Address - Country:US
Practice Address - Phone:518-478-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist