Provider Demographics
NPI:1508438912
Name:VERRILLO, GABRIELLE (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:GABRIELLE
Middle Name:
Last Name:VERRILLO
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 1:214 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2301
Mailing Address - Country:US
Mailing Address - Phone:267-804-0838
Mailing Address - Fax:
Practice Address - Street 1:401 E HANCOCK ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-3961
Practice Address - Country:US
Practice Address - Phone:770-908-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0134624235Z00000X
PASL017364235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist