Provider Demographics
NPI:1407983398
Name:SIMONE, GABRIELLE (AUD)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:SIMONE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-6153
Mailing Address - Country:US
Mailing Address - Phone:781-272-2550
Mailing Address - Fax:
Practice Address - Street 1:11 BELMONT RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5102
Practice Address - Country:US
Practice Address - Phone:781-272-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA704231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist