Provider Demographics
NPI:1124583976
Name:BISKUPIC, GINA DIANNE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:DIANNE
Last Name:BISKUPIC
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:DIANNE
Other - Last Name:DIALESSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 HILLARY LN
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-9404
Mailing Address - Country:US
Mailing Address - Phone:413-519-8255
Mailing Address - Fax:
Practice Address - Street 1:23 HILLARY LN
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-9404
Practice Address - Country:US
Practice Address - Phone:413-519-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4528235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist