Provider Demographics
NPI:1871194738
Name:CARRANCO, GABRIELA (SLP)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:CARRANCO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 FM 967 # A
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-3461
Mailing Address - Country:US
Mailing Address - Phone:512-295-2273
Mailing Address - Fax:512-295-2280
Practice Address - Street 1:1750 FM 967 # A
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3461
Practice Address - Country:US
Practice Address - Phone:512-295-2273
Practice Address - Fax:512-295-2280
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116773OtherSPEECH THERAPIST LICENSE NUMBER