Provider Demographics
NPI:1306981048
Name:DURKOTA, GAIL MACLIN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:MACLIN
Last Name:DURKOTA
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 1:201 S PEACH ST
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-2325
Mailing Address - Country:US
Mailing Address - Phone:618-542-2190
Mailing Address - Fax:
Practice Address - Street 1:1108 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1138
Practice Address - Country:US
Practice Address - Phone:618-549-4442
Practice Address - Fax:618-549-0231
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist