Basic Information
| Provider Information | |||||||||
| NPI: | 1144256512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRESS | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | JEAN DELASSUS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | SC.D, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10190 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234500190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004775240 | ||||||||
| FaxNumber: | 7572161638 | ||||||||
| Practice Location | |||||||||
| Address1: | 8303 DODGE ST | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681144108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023545048 | ||||||||
| FaxNumber: | 4023542585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 03/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2202004204 | VA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 9054 | CA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 1802 | NE | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 10026075400 | 05 | NE | MEDICAID |