Provider Demographics
NPI:1386833556
Name:WEAVER, GAYLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 N MCMULLEN BOOTH RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1349
Mailing Address - Country:US
Mailing Address - Phone:888-974-7878
Mailing Address - Fax:727-726-1825
Practice Address - Street 1:2455 N MCMULLEN BOOTH RD STE C
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1349
Practice Address - Country:US
Practice Address - Phone:888-974-7878
Practice Address - Fax:727-726-1825
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist