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General NPI Number Information
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NPI Number | 1245893429
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Entity Type | Individual
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Provider Name | GISELE MARIE PATRICK M.A., CCC SP
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Gender | Female
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 50 E FOOTHILL BLVD
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City | ARCADIA
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State | CA
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Zip | 91006-2314
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Country | US
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Telephone | 626-445-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 2475 ADAIR ST
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City | SAN MARINO
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State | CA
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Zip | 91108-2611
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Country | US
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Telephone | 626-390-2440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP17701
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License Number State | CA
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