Provider Demographics
NPI:1407169527
Name:WHITE, GEMMA SARAH (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GEMMA
Middle Name:SARAH
Last Name:WHITE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 W 238TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1404
Mailing Address - Country:US
Mailing Address - Phone:917-579-8162
Mailing Address - Fax:
Practice Address - Street 1:634 W 238TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1404
Practice Address - Country:US
Practice Address - Phone:917-579-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017444235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist