Provider Demographics
NPI:1912689316
Name:GILBERT, STEPHANIE RENE (MCD CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENE
Last Name:GILBERT
Suffix:
Gender:
Credentials:MCD CCC-SLP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RENE
Other - Last Name:CHUSTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD CCC-SLP
Mailing Address - Street 1:4242 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3970
Mailing Address - Country:US
Mailing Address - Phone:225-328-8004
Mailing Address - Fax:
Practice Address - Street 1:4242 POPLAR ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3970
Practice Address - Country:US
Practice Address - Phone:225-328-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8653235Z00000X
TX121279235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist