Healthcare Provider Details

I. General information

NPI: 1750149167
Provider Name (Legal Business Name): GISELLE SOTO CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N COURT ST
WESTMINSTER MD
21157-5192
US

IV. Provider business mailing address

272 ENGLISH LAKES BLVD
AMHERST OH
44001-3422
US

V. Phone/Fax

Practice location:
  • Phone: 410-751-3033
  • Fax:
Mailing address:
  • Phone: 412-390-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10947
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: