Provider Demographics
NPI:1235936881
Name:LIBERTY, GABRIELLE (SLPA)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:LIBERTY
Suffix:
Gender:
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 W SEA CREST DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6620
Mailing Address - Country:US
Mailing Address - Phone:201-669-1969
Mailing Address - Fax:
Practice Address - Street 1:1232 W SEA CREST DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-6620
Practice Address - Country:US
Practice Address - Phone:201-669-1969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA158972355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant