Provider Demographics
NPI:1770735805
Name:GILBERTSON, MARGIE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARGIE
Middle Name:
Last Name:GILBERTSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SEGOVIA DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909-2643
Mailing Address - Country:US
Mailing Address - Phone:501-922-4342
Mailing Address - Fax:
Practice Address - Street 1:31 SEGOVIA DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-2643
Practice Address - Country:US
Practice Address - Phone:501-922-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP680235Z00000X
ARA-107231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4A340OtherMEDICARE PTAN/ID