Provider Demographics
NPI:1174714356
Name:GASPARD-ST. CYR, DOROTHY C (SLP)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:C
Last Name:GASPARD-ST. CYR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-4622
Mailing Address - Country:US
Mailing Address - Phone:540-720-2261
Mailing Address - Fax:
Practice Address - Street 1:2604 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-5011
Practice Address - Country:US
Practice Address - Phone:540-720-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA299916OtherBS029
VA299917OtherBS029