Provider Demographics
NPI:1073221214
Name:BAZZI, GABRIELLE ALI
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ALI
Last Name:BAZZI
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 1:26832 ROCHELLE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3646
Mailing Address - Country:US
Mailing Address - Phone:313-686-1259
Mailing Address - Fax:
Practice Address - Street 1:26832 ROCHELLE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3646
Practice Address - Country:US
Practice Address - Phone:313-686-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0095958284Medicaid