MEDICARE: WHITNEY MARIE GAMA

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	2355S0801X	Speech-Language Assistant	40483	TX

General Provider Information

NPI Number	:	1790323855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY MARIE GAMA

Provider Business Mailing Address
First Line	:	4207 GARDENDALE ST STE 104B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 GARDENDALE ST STE 104B
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3142
Country	:	US
Telephone Number	:	210-582-5840
Fax Number	:

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

Provider Enumeration Date	:	12/19/2019
Last Update Date	:	12/19/2019

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Directions to “ WHITNEY MARIE GAMA ” Practice Location

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