Provider Demographics
NPI:1780164681
Name:GILBERTSON, STEPHANIE GAIL (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:GAIL
Last Name:GILBERTSON
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1201 HEWITT DR STE 107
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8834
Mailing Address - Country:US
Mailing Address - Phone:254-572-8890
Mailing Address - Fax:254-231-3754
Practice Address - Street 1:3411 SOUTH 31ST STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502
Practice Address - Country:US
Practice Address - Phone:254-231-3752
Practice Address - Fax:254-231-3754
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist