Gina Clouse, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Greenwood, MO
NPI 1174783328 · NPPES record last updated Nov 1, 2011
Key facts
- NPI
- 1174783328
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 2009001043 (MO)
- Practice address
- 1603 Kimberly CT
Greenwood, MO 64034-8700 - Phone
- (816) 808-7216
- NPI assigned
- Jun 11, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 146009373 | IL | MD | Speech-Language Pathologist |
| 2009001043 | MO | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 146009373 | IL | |
| Speech-Language Pathologist | 235Z00000X | 2009001043 | MO | Yes |
Addresses
Primary practice location
1603 Kimberly CT
Greenwood, MO 64034-8700
Mailing address
1603 Kimberly CT
Greenwood, MO 64034-8700
Phone (816) 808-7216
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All providers in Greenwood, MO · Speech-Language Pathologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 1, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.