Provider Demographics
NPI:1437973401
Name:GIBSON, AYLA ANTOINETTE
Entity type:Individual
Prefix:
First Name:AYLA
Middle Name:ANTOINETTE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AYLA
Other - Middle Name:
Other - Last Name:GAMOTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2115 E SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4332
Mailing Address - Country:US
Mailing Address - Phone:307-258-9786
Mailing Address - Fax:
Practice Address - Street 1:2115 E SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4332
Practice Address - Country:US
Practice Address - Phone:307-258-9786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health