Provider Demographics
NPI:1821803958
Name:GAMBLE, LILA JANE (SLP)
Entity type:Individual
Prefix:
First Name:LILA
Middle Name:JANE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 N SHILOH AVE
Mailing Address - Street 2:
Mailing Address - City:KENESAW
Mailing Address - State:NE
Mailing Address - Zip Code:68956-1648
Mailing Address - Country:US
Mailing Address - Phone:402-461-6413
Mailing Address - Fax:
Practice Address - Street 1:3735 N SHILOH AVE
Practice Address - Street 2:
Practice Address - City:KENESAW
Practice Address - State:NE
Practice Address - Zip Code:68956-1648
Practice Address - Country:US
Practice Address - Phone:402-461-6413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion