Provider Demographics
NPI:1447674718
Name:GIDLEY, VONNETTA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:VONNETTA
Middle Name:
Last Name:GIDLEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WINDING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4166
Mailing Address - Country:US
Mailing Address - Phone:202-725-1196
Mailing Address - Fax:
Practice Address - Street 1:306 WINDING HILLS DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4166
Practice Address - Country:US
Practice Address - Phone:202-725-1196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3895235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist