Provider Demographics
NPI:1740945815
Name:FIRESTONE, GABRIELLE MACKENZIE (AUD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:MACKENZIE
Last Name:FIRESTONE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:MACKENZIE
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1716 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4045
Mailing Address - Country:US
Mailing Address - Phone:513-835-2552
Mailing Address - Fax:
Practice Address - Street 1:1766 MAJESTIC LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6759
Practice Address - Country:US
Practice Address - Phone:513-835-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02330231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist