Provider Demographics
NPI:1285474742
Name:HORNBERGER, GISELA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:HORNBERGER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 FISH POND LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5947
Mailing Address - Country:US
Mailing Address - Phone:804-484-5231
Mailing Address - Fax:
Practice Address - Street 1:2420 PEMBERTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-2003
Practice Address - Country:US
Practice Address - Phone:804-747-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist