Individual
GINA DOMBALIS PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
185 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1521
(336) 725-0222
Mailing address
1453 BEAVERTON TRL, WINSTON SALEM, NC 27103-5270
(336) 575-6637
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5526
NC
Other
Enumeration date
12/15/2022
Last updated
12/15/2022
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