Provider Demographics
NPI:1073812780
Name:DECICCO, GAIL LEE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:LEE
Last Name:DECICCO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-2173
Mailing Address - Country:US
Mailing Address - Phone:518-588-9227
Mailing Address - Fax:
Practice Address - Street 1:10 SPRING ST
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025-2173
Practice Address - Country:US
Practice Address - Phone:518-588-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist