MEDICARE: GISELLE CHERISE GOULBOURNE 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
1	235Z00000X	Speech-Language Pathologist	SLP007496	GA
2	235Z00000X	Speech-Language Pathologist	MSSLP.0000014	CO

General Provider Information

NPI Number	:	1558667725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GISELLE CHERISE GOULBOURNE SLP

Provider Business Mailing Address
First Line	:	842 N HIGHLAND AVE NE
Second Line	:	SUITE 275
City	:	ATLANTA
State	:	GA
Zip	:	30306-4530
Country	:	US
Telephone Number	:	404-575-4000
Fax Number	:	404-575-4010

Provider Business Practice Location Address
First Line	:	1296 CREE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915-3167
Country	:	US
Telephone Number	:	407-443-6149
Fax Number	:

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

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	12/16/2024

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Directions to “ GISELLE CHERISE GOULBOURNE SLP” Practice Location

Language	Start Address	Practice Location

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