Provider Demographics
NPI:1275241457
Name:HOLMES, GABRIELLE ANNE (CCC)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANNE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5951 NW 63RD TER UNIT 1226
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-3529
Mailing Address - Country:US
Mailing Address - Phone:308-293-2496
Mailing Address - Fax:
Practice Address - Street 1:3965 W 83RD ST STE 126
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5308
Practice Address - Country:US
Practice Address - Phone:913-945-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022038365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist