Provider Demographics
NPI:1881301380
Name:WILSON, GABRIELLE GEORGE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:GEORGE
Last Name:WILSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 GARDENA DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-1914
Mailing Address - Country:US
Mailing Address - Phone:504-373-6267
Mailing Address - Fax:
Practice Address - Street 1:1456 GARDENA DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-1914
Practice Address - Country:US
Practice Address - Phone:504-373-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist