Provider Demographics
NPI:1508987660
Name:GAGLIARDI, REBECCA L (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:GAGLIARDI
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 1:1800 CHARMUTH GARTH
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5207
Mailing Address - Country:US
Mailing Address - Phone:443-226-1409
Mailing Address - Fax:
Practice Address - Street 1:1818 POT SPRING RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4445
Practice Address - Country:US
Practice Address - Phone:410-583-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MD05252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist