Provider Demographics
NPI:1386033611
Name:GUNNIP, DEBRA (MS)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:GUNNIP
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W HYERDALE DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:CT
Mailing Address - Zip Code:06756-1705
Mailing Address - Country:US
Mailing Address - Phone:860-491-3004
Mailing Address - Fax:
Practice Address - Street 1:1 RESERVOIR OFFICE PARK STE 104
Practice Address - Street 2:1449 OLD WATERBURY ROAD
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3926
Practice Address - Country:US
Practice Address - Phone:203-262-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-114022235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist