Healthcare Provider Details

I. General information

NPI: 1578966545
Provider Name (Legal Business Name): ELIZABETH GEBBIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MCKENNANS CHURCH RD
WILMINGTON DE
19808-1327
US

IV. Provider business mailing address

55A S MEADOWOOD DR
NEWARK DE
19711-6755
US

V. Phone/Fax

Practice location:
  • Phone: 302-992-5520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberO4-0000405
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: