Doctor Name: | BRENDA GILLAR |
NPI Number: | 1063882033 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC/SLP |
License Number: | 111703 |
Business Practice Address: | 1809 W Loop 281 Ste100 Pmb153 Longview, TX - 756042571 |
Business Phone Number: | 9729354752 |
Business Fax Number: | |
Mailing Address: | 1809 W Loop 281, Ste100 Pmb153 LONGVIEW |
State: | TX |
Postal Code: | 756042571 |
Phone Number: | 9729354752 |
Fax Number: | |
NPI Enumeration Date: | 10/02/2015 |
NPI Last Update Date: | 10/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 111703 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |