Basic Information
| Provider Information | |||||||||
| NPI: | 1144664657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITE | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | GILL | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GILL | ||||||||
| OtherFirstName: | SANDRA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | M.S | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6301 CAMPUS CIRCLE DR E | ||||||||
| Address2: | SUITE 100A | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750632712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693740700 | ||||||||
| FaxNumber: | 4693740800 | ||||||||
| Practice Location | |||||||||
| Address1: | 6301 CAMPUS CIRCLE DR E | ||||||||
| Address2: | SUITE 100A | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750632712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693740700 | ||||||||
| FaxNumber: | 4693740800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2013 | ||||||||
| LastUpdateDate: | 04/26/2013 | ||||||||
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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 | 11499 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.