Provider Demographics
NPI:1912267097
Name:GILSON, ELIZABETH SUZANNE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUZANNE
Last Name:GILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3407
Mailing Address - Country:US
Mailing Address - Phone:707-330-8931
Mailing Address - Fax:707-265-8343
Practice Address - Street 1:3353 BEARD RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3407
Practice Address - Country:US
Practice Address - Phone:707-330-8931
Practice Address - Fax:707-265-8343
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7019237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist