Basic Information
| Provider Information | |||||||||
| NPI: | 1679829345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANCINAS | ||||||||
| FirstName: | GISELLE | ||||||||
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| Credential: | SLP INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12371 S KIRKWOOD RD | ||||||||
| Address2: | |||||||||
| City: | STAFFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774772836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139959292 | ||||||||
| FaxNumber: | 7137790204 | ||||||||
| Practice Location | |||||||||
| Address1: | 2425 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEAGUE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775732743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812846600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2012 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | 36871 | TX | N | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | 235Z00000X | 120349 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.