Healthcare Provider Details

I. General information

NPI: 1063177541
Provider Name (Legal Business Name): CINDY BETH GILKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PINKERTON ST
DERRY NH
03038-1515
US

IV. Provider business mailing address

2 MEREDITH RD
SALEM NH
03079-4249
US

V. Phone/Fax

Practice location:
  • Phone: 603-479-9453
  • Fax:
Mailing address:
  • Phone: 603-479-9453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number87382
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: