Provider Demographics
NPI:1508985698
Name:GALLEGOS, GISELLE M (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:M
Last Name:GALLEGOS
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 1:2611 SANTA CLARA LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-5189
Mailing Address - Country:US
Mailing Address - Phone:505-647-1149
Mailing Address - Fax:505-523-1108
Practice Address - Street 1:780 S WALNUT ST
Practice Address - Street 2:BLDY #7
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1425
Practice Address - Country:US
Practice Address - Phone:505-526-1161
Practice Address - Fax:505-523-1108
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3523235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist