Provider Demographics
NPI:1093961013
Name:GERGELY, CHRISTINA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:GERGELY
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 1:3407 HEATHER BROOK LN
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-8731
Mailing Address - Country:US
Mailing Address - Phone:585-260-2776
Mailing Address - Fax:
Practice Address - Street 1:3407 HEATHER BROOK LN
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8731
Practice Address - Country:US
Practice Address - Phone:585-260-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-10
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013931-1252Y00000X
NY013931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No252Y00000XAgenciesEarly Intervention Provider Agency