Provider Demographics
NPI:1316221591
Name:GALLAGHER, THERESA (MS, CCC-SLP, BCBA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MS, CCC-SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2838
Mailing Address - Country:US
Mailing Address - Phone:201-978-4076
Mailing Address - Fax:
Practice Address - Street 1:195 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2838
Practice Address - Country:US
Practice Address - Phone:201-978-4076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00081800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist