Provider Demographics
NPI:1801913140
Name:COMPTON, GAYLE RENEE (MS CCC SLP)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:RENEE
Last Name:COMPTON
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6724 STALEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-9137
Mailing Address - Country:US
Mailing Address - Phone:336-685-9782
Mailing Address - Fax:
Practice Address - Street 1:111 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:GIBSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27249-2450
Practice Address - Country:US
Practice Address - Phone:336-449-4055
Practice Address - Fax:336-449-7368
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC24015OtherBCBS
NC3403407Medicaid