Provider Demographics
NPI:1154141695
Name:GILBERT, JEAN-LUC (MA CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:JEAN-LUC
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15959 HALL RD STE 410
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5365
Mailing Address - Country:US
Mailing Address - Phone:586-416-6290
Mailing Address - Fax:586-416-6295
Practice Address - Street 1:15959 HALL RD STE 410
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5365
Practice Address - Country:US
Practice Address - Phone:586-416-6290
Practice Address - Fax:586-416-6295
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101008190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist