Healthcare Provider Details

I. General information

NPI: 1528184983
Provider Name (Legal Business Name): GLORIA L BUCKLEY AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 ABRAMS RD
DALLAS TX
75214-2607
US

IV. Provider business mailing address

4130 ABRAMS RD
DALLAS TX
75214-2607
US

V. Phone/Fax

Practice location:
  • Phone: 214-827-1900
  • Fax: 214-821-8106
Mailing address:
  • Phone: 214-827-1900
  • Fax: 214-821-8106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number50332
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: