Provider Demographics
NPI:1407152069
Name:GAMMONS, ROBERTA POSLUSNY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:POSLUSNY
Last Name:GAMMONS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BRYAN ST
Mailing Address - Street 2:VIRGIL I. GRISSOM SCHOOL #7
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-1714
Mailing Address - Country:US
Mailing Address - Phone:585-254-3110
Mailing Address - Fax:
Practice Address - Street 1:31 BRYAN ST
Practice Address - Street 2:VIRGIL I. GRISSOM SCHOOL #7
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-1714
Practice Address - Country:US
Practice Address - Phone:585-254-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4238-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist