Provider Demographics
NPI:1053822965
Name:GULLAPALLI, GIRIJA
Entity Type:Individual
Prefix:
First Name:GIRIJA
Middle Name:
Last Name:GULLAPALLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1245
Mailing Address - Country:US
Mailing Address - Phone:708-724-0040
Mailing Address - Fax:
Practice Address - Street 1:160 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-2408
Practice Address - Country:US
Practice Address - Phone:708-442-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist