Organization
GIBSON OF JAX, INC.
Active
Other names
Katherine W. Gibson, MA, CCC-SLP
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHERINE WOODY GIBSON MA, CCC-SLP (PRESIDENT)
(904) 254-0337
Entity
Organization
Contact information
Practice address
3775 CRICKET COVE RD E, JACKSONVILLE, FL 32224-8401
(904) 254-0337
(904) 223-4368
Mailing address
3775 CRICKET COVE RD E, JACKSONVILLE, FL 32224-8401
(904) 254-0337
(904) 223-4368
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
SA 5525
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356441828
INDIVIDUAL NPI
—
05
—
885295200
—
FL
Enumeration date
09/17/2009
Last updated
09/17/2009
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