Provider Demographics
NPI:1861069189
Name:DE LEON, GABRIELA MICHELLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:MICHELLE
Last Name:DE LEON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6531 COUNTY ROAD 110 APT 228
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1629
Mailing Address - Country:US
Mailing Address - Phone:512-961-2626
Mailing Address - Fax:
Practice Address - Street 1:3944 RR 620 S STE 206
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-7000
Practice Address - Country:US
Practice Address - Phone:512-645-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
TX118164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist