Provider Demographics
NPI:1083671291
Name:JABLONSKI, GREGORY MICHAEL (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:MICHAEL
Last Name:JABLONSKI
Suffix:
Gender:M
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:CMR 427 BOX 2385
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09630
Mailing Address - Country:US
Mailing Address - Phone:39044-471-7471
Mailing Address - Fax:39044-471-7222
Practice Address - Street 1:CMR 427 BOX 2385
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09630
Practice Address - Country:US
Practice Address - Phone:39044-471-7471
Practice Address - Fax:39044-471-7222
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005065L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist