Provider Demographics
NPI:1093222887
Name:DUPREY, GINA FORTE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:FORTE
Last Name:DUPREY
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 1:31 E NEWELL AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2305
Mailing Address - Country:US
Mailing Address - Phone:201-906-9570
Mailing Address - Fax:
Practice Address - Street 1:31 E NEWELL AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2305
Practice Address - Country:US
Practice Address - Phone:201-906-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00836900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist