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NPI Code Detail

MEDICARE: EBONI GIPSON SLP

MEDICARE: EBONI GIPSON SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1235430901
Entity Type Code : Individual
Provider Name (Legal Business Name) : EBONI GIPSON SLP
Provider Business Mailing Address
First Line : 19717 PRAIRIE ST
Second Line :
City : DETROIT
State : MI
Zip : 48221-1729
Country : US
Telephone Number : 313-204-4423
Fax Number :
Provider Business Practice Location Address
First Line : 516 176TH ST E
Second Line :
City : SPANAWAY
State : WA
Zip : 98387-8335
Country : US
Telephone Number : 313-204-4423
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2010
Last Update Date : 11/10/2010

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Directions to “ EBONI GIPSON SLP” Practice Location

Language Start Address Practice Location
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