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NPI Code Detail

MEDICARE: MRS. GABRIELLA LOVATO TICKNER SLPA

MEDICARE: MRS. GABRIELLA LOVATO TICKNER SLPA
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
12355S0801XSpeech-Language AssistantCA

General Provider Information

NPI Number : 1487436044
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GABRIELLA LOVATO TICKNER SLPA
Provider Business Mailing Address
First Line : 1113 AMHERST AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90049-5805
Country : US
Telephone Number : 310-857-8497
Fax Number :
Provider Business Practice Location Address
First Line : 1034 W OAK GROVE RD
Second Line :
City : MONTROSE
State : CO
Zip : 81403-4757
Country : US
Telephone Number : 970-596-7446
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2023
Last Update Date : 10/18/2023

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Directions to “ MRS. GABRIELLA LOVATO TICKNER SLPA” Practice Location

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