Provider Demographics
NPI:1083860001
Name:GARBELLANO-VERGINE, KRISTA LEE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LEE
Last Name:GARBELLANO-VERGINE
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 1:551 E STATION AVE
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-2027
Mailing Address - Country:US
Mailing Address - Phone:484-865-9220
Mailing Address - Fax:484-353-5157
Practice Address - Street 1:551 E STATION AVE
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-2027
Practice Address - Country:US
Practice Address - Phone:484-865-9220
Practice Address - Fax:484-353-5157
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-10
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012724235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist