Provider Demographics
NPI:1982943296
Name:TERAN, GILLIAN GLADSTONE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:GLADSTONE
Last Name:TERAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:GILLIAN
Other - Middle Name:
Other - Last Name:GLADSTONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:5808 INMAN PARK CIR APT 200
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-5470
Mailing Address - Country:US
Mailing Address - Phone:240-731-7516
Mailing Address - Fax:
Practice Address - Street 1:5808 INMAN PARK CIR APT 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-5470
Practice Address - Country:US
Practice Address - Phone:240-731-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06665235Z00000X
DCSLP000492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist