Provider Demographics
NPI:1376226100
Name:GALLEGO-POURMAND, MONICA MARIA (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:MARIA
Last Name:GALLEGO-POURMAND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:MARIA
Other - Last Name:GALLEGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1273 HARDSCRABBLE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-1913
Mailing Address - Country:US
Mailing Address - Phone:646-591-0510
Mailing Address - Fax:
Practice Address - Street 1:40 W TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5400
Practice Address - Country:US
Practice Address - Phone:718-583-5355
Practice Address - Fax:718-583-5885
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032352-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty