Basic Information
| Provider Information | |||||||||
| NPI: | 1306974852 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | ELLA | ||||||||
| MiddleName: | TB | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 SHERBORNE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296152922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642683718 | ||||||||
| FaxNumber: | 8642683718 | ||||||||
| Practice Location | |||||||||
| Address1: | 1941 SAVAGE RD. | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665712700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 3742 | SC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 006069 | GA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.