Provider Demographics
NPI:1346484110
Name:NATHANSON, GAIL (MA/CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:
Last Name:NATHANSON
Suffix:
Gender:F
Credentials:MA/CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 LINDAMERE CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-5541
Mailing Address - Country:US
Mailing Address - Phone:973-650-6108
Mailing Address - Fax:
Practice Address - Street 1:1827 KNOLL DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7321
Practice Address - Country:US
Practice Address - Phone:805-667-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9138235Z00000X
CA35622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist