Provider Demographics
NPI:1437465077
Name:SEIFERT, GINA M (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:SEIFERT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 KOENIGSTEIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3664
Mailing Address - Country:US
Mailing Address - Phone:402-644-7396
Mailing Address - Fax:402-644-7394
Practice Address - Street 1:1500 KOENIGSTEIN AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3664
Practice Address - Country:US
Practice Address - Phone:402-644-7396
Practice Address - Fax:402-644-7394
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist