MEDICARE: MRS. GABRIELLE EXIA PINKSTON M.S., CCC-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	4220	OK

General Provider Information

NPI Number	:	1629449202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GABRIELLE EXIA PINKSTON M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	13771 S OAK ST
Second Line	:
City	:	GLENPOOL
State	:	OK
Zip	:	74033-3247
Country	:	US
Telephone Number	:	918-733-2531
Fax Number	:

Provider Business Practice Location Address
First Line	:	7225 TWIN HILLS RD
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-2053
Country	:	US
Telephone Number	:	918-733-2531
Fax Number	:

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

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	10/08/2015

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Directions to “ MRS. GABRIELLE EXIA PINKSTON M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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