Provider Demographics
NPI:1497020259
Name:GASLOW, BROOKE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:GASLOW
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 1:552 ADIRONDACK CT
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2743
Mailing Address - Country:US
Mailing Address - Phone:201-962-2592
Mailing Address - Fax:
Practice Address - Street 1:1751 ROUTE 17A
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921
Practice Address - Country:US
Practice Address - Phone:845-341-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist