Individual
DR. KELLY A GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
4725 HOEN AVE, SANTA ROSA, CA 95405-9402
(707) 542-1154
(707) 542-4818
Mailing address
750 N COMMONS DR STE 200, AURORA, IL 60504-7940
(630) 303-5380
(630) 303-5385
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
AU 2679
CA
231HA2400X
Assistive Technology Practitioner Audiologist
AU 2679
CA
231HA2500X
Assistive Technology Supplier Audiologist
AU 2679
CA
237600000X
Audiologist-Hearing Aid Fitter
Primary
AU 2679
CA
237700000X
Hearing Instrument Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB279930
MEDICARE
CA
Enumeration date
03/14/2007
Last updated
09/29/2022
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