Provider Demographics
NPI:1063818417
Name:GABRIELLI, GINA (AUD)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:GABRIELLI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 SE 32ND AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6587
Mailing Address - Country:US
Mailing Address - Phone:503-513-8630
Mailing Address - Fax:503-513-8196
Practice Address - Street 1:10330 SE 32ND AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6587
Practice Address - Country:US
Practice Address - Phone:503-513-8630
Practice Address - Fax:503-513-8196
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60632345231H00000X
CAAU2977231H00000X
OR30850231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist