Provider Demographics
NPI:1992494488
Name:GIBSON, LORRAINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:GIBSON
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 1:12145 SAM SNEAD HWY
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:24484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98 PANTHER DR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:24445-2672
Practice Address - Country:US
Practice Address - Phone:540-839-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist