Linda Gamboa, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.000325 Issued in IL

Practice address

10110 Old Lincoln TRL
Fairview Heights, IL 62208-2422

Phone

(618) 397-2764

NPI assigned

Dec 5, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grant Community School District 110

  • Local Education Agency (LEA)
  • Fairview Heights, IL
  • NPI 1649492133
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393545600000",
    "number": "1326479015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10110 OLD LINCOLN TRL",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082422",
            "telephone_number": "618-397-2764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10110 OLD LINCOLN TRL",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082422",
            "telephone_number": "618-397-2764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBOA",
        "first_name": "LINDA",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-05",
        "last_updated": "2014-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.000325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Frazure, LCSW
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• Angela M. Froidcoeur, D.M.D.
• Faith Genevieve Fude, MS, RD, LD
• Kiyah Ann Galvin
• Jeanette W Georgen, MA, LCPC, ATR
• Matthew Michael Germann, PA-C
• Joshua Gibson, APRN FNP-C
• Malik Yusef Giddens, RBT
• Rachael Lyna Gillis, RBT

• Speech-Language Pathologist in Fairview Heights, IL
• Providers in Fairview Heights, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.