Provider Demographics
NPI:1457859217
Name:PETRO, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:PETRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 E BURR OAK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1660
Mailing Address - Country:US
Mailing Address - Phone:847-670-3400
Mailing Address - Fax:847-670-3418
Practice Address - Street 1:1209 E BURR OAK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1660
Practice Address - Country:US
Practice Address - Phone:847-670-3400
Practice Address - Fax:847-670-3418
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist