Provider Demographics
NPI:1194072223
Name:GABRIELSE, PATRICIA MARIE (MS, CCC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARIE
Last Name:GABRIELSE
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:MARIE
Other - Last Name:HANDLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC
Mailing Address - Street 1:410 PROVIDENCE LANE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-493-4995
Mailing Address - Fax:360-493-4470
Practice Address - Street 1:410 PROVIDENCE LANE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-493-4995
Practice Address - Fax:360-493-4470
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001229235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist