Provider Demographics
NPI:1073129128
Name:CRESCENT, GILLIAN NOEL
Entity Type:Individual
Prefix:
First Name:GILLIAN
Middle Name:NOEL
Last Name:CRESCENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GILLIAN
Other - Middle Name:NOEL
Other - Last Name:GAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10G DENISE DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5025
Mailing Address - Country:US
Mailing Address - Phone:315-420-9846
Mailing Address - Fax:
Practice Address - Street 1:127 BLOOMINGROVE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8404
Practice Address - Country:US
Practice Address - Phone:518-687-0357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist