Provider Demographics
NPI:1316071970
Name:GILHOOLY, GERTRUDE PATRICIA (MS, CCC-SLP, CCC-A)
Entity type:Individual
Prefix:MS
First Name:GERTRUDE
Middle Name:PATRICIA
Last Name:GILHOOLY
Suffix:
Gender:F
Credentials:MS, CCC-SLP, CCC-A
Other - Prefix:
Other - First Name:TRUDI
Other - Middle Name:PATRICIA
Other - Last Name:GILHOOLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP, CCC-A
Mailing Address - Street 1:4161 S HULEN ST
Mailing Address - Street 2:APT 1426
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4975
Mailing Address - Country:US
Mailing Address - Phone:210-833-1214
Mailing Address - Fax:
Practice Address - Street 1:4161 S HULEN ST
Practice Address - Street 2:APT 1426
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4975
Practice Address - Country:US
Practice Address - Phone:210-833-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50634231H00000X
TX14299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216699301Medicaid
TX81S005OtherBLUE CROSS BLUE SHIELD
TX2166993-02Medicaid