Provider Demographics
NPI:1487436044
Name:TICKNER, GABRIELLA LOVATO (SLPA)
Entity type:Individual
Prefix:MRS
First Name:GABRIELLA
Middle Name:LOVATO
Last Name:TICKNER
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5805
Mailing Address - Country:US
Mailing Address - Phone:310-857-8497
Mailing Address - Fax:
Practice Address - Street 1:1034 W OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81403-4757
Practice Address - Country:US
Practice Address - Phone:970-596-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant