Provider Demographics
NPI:1104429067
Name:GATTEN, BARCLAY BURDETTE
Entity type:Individual
Prefix:
First Name:BARCLAY
Middle Name:BURDETTE
Last Name:GATTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W NORTH LOOP BLVD APT 1037
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2031
Mailing Address - Country:US
Mailing Address - Phone:757-653-7193
Mailing Address - Fax:
Practice Address - Street 1:4100 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6056
Practice Address - Country:US
Practice Address - Phone:512-454-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist