Provider Demographics
NPI:1316205446
Name:CARDILLO, GINA CATHERINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:CATHERINE
Last Name:CARDILLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:CATHERINE
Other - Last Name:LEBEDEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2410 N 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8439
Mailing Address - Country:US
Mailing Address - Phone:206-790-4957
Mailing Address - Fax:
Practice Address - Street 1:16120 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-3937
Practice Address - Country:US
Practice Address - Phone:425-747-4004
Practice Address - Fax:425-747-1069
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60570918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist