Individual
MS. JACQUELINE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
1904 ORMOND BLVD STE 201, DESTREHAN, LA 70047-3829
(504) 388-1606
Mailing address
PO BOX 1542, WESTWEGO, LA 70096-1542
(504) 460-0096
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2029
LA
Other
Enumeration date
09/25/2009
Last updated
09/25/2009
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