Healthcare Provider Details

I. General information

NPI: 1700839867
Provider Name (Legal Business Name): ALICIA BESS ANITA GILLON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CORNING RD
CARY NC
27518-9229
US

IV. Provider business mailing address

812 ATLANTIS ST
FUQUAY VARINA NC
27526-3241
US

V. Phone/Fax

Practice location:
  • Phone: 919-588-3410
  • Fax:
Mailing address:
  • Phone: 919-609-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7293
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: