Provider Demographics
NPI:1518262823
Name:GALLAGHER, NOREEN R (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:R
Last Name:GALLAGHER
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 1:1801 MAIN STREET
Mailing Address - Street 2:EAST EAST HIGH SCHOOL
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609
Mailing Address - Country:US
Mailing Address - Phone:585-288-3130
Mailing Address - Fax:585-654-1066
Practice Address - Street 1:1801 MAIN STREET EAST
Practice Address - Street 2:EAST HIGH SCHOOL
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609
Practice Address - Country:US
Practice Address - Phone:585-288-3130
Practice Address - Fax:585-654-1066
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist