Provider Demographics
NPI:1487132270
Name:HINES, GELASIA BERNADETTE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GELASIA
Middle Name:BERNADETTE
Last Name:HINES
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 1:1300 N 45TH ST APT 511
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-1718
Mailing Address - Country:US
Mailing Address - Phone:903-851-4947
Mailing Address - Fax:
Practice Address - Street 1:2800 SUDITH LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-6605
Practice Address - Country:US
Practice Address - Phone:972-775-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist