MEDICARE: GAELLA DOUTIS 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	SP-2905	NV

General Provider Information

NPI Number	:	1578156378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAELLA DOUTIS SLP

Provider Business Mailing Address
First Line	:	7635 RIBBON GARLAND CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-5411
Country	:	US
Telephone Number	:	702-499-2410
Fax Number	:

Provider Business Practice Location Address
First Line	:	7635 RIBBON GARLAND CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-5411
Country	:	US
Telephone Number	:	702-499-2410
Fax Number	:

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

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	04/13/2023

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Directions to “ GAELLA DOUTIS SLP” Practice Location

Language	Start Address	Practice Location

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