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

LicenseStateTypeSpecialty
146009373ILMDSpeech-Language Pathologist
2009001043MOMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
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

Other providers in Greenwood, MO

All providers in Greenwood, MO · Speech-Language Pathologist in Missouri

Sources for this page

Verify at the official NPI Registry.