Individual
BLAKE NICOLE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
4901 BRYANT IRVIN RD N STE 200, FORT WORTH, TX 76107-7673
(817) 433-9742
Mailing address
10917 LOS RIOS DR, FORT WORTH, TX 76179-6842
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
122638
TX
Other
Enumeration date
07/02/2026
Last updated
07/02/2026
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