Provider Demographics
NPI:1871048108
Name:GILBO, MARY GRACE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:GRACE
Last Name:GILBO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:GRACE
Other - Last Name:ROSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2493 MILFORD RD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-9720
Mailing Address - Country:US
Mailing Address - Phone:570-424-1706
Mailing Address - Fax:570-424-6711
Practice Address - Street 1:2493 MILFORD RD
Practice Address - Street 2:SUITE #300
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9720
Practice Address - Country:US
Practice Address - Phone:570-424-1706
Practice Address - Fax:570-424-6711
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL013084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist