MEDICARE: MS. GERTRUDE PATRICIA GILHOOLY M.S., CCC-SLP, CCC-A

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
1	231H00000X	Audiologist	50634	TX
2	235Z00000X	Speech-Language Pathologist	14299	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	81S005	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316071970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GERTRUDE PATRICIA GILHOOLY M.S., CCC-SLP, CCC-A

Provider Business Mailing Address
First Line	:	4161 S HULEN ST
Second Line	:	APT 1426
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4975
Country	:	US
Telephone Number	:	210-833-1214
Fax Number	:

Provider Business Practice Location Address
First Line	:	4161 S HULEN ST
Second Line	:	APT 1426
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4975
Country	:	US
Telephone Number	:	210-833-1214
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/28/2012

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Directions to “ MS. GERTRUDE PATRICIA GILHOOLY M.S., CCC-SLP, CCC-A” Practice Location

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