Provider Demographics
NPI:1528375722
Name:MOORE, GABRIELLE HOLDER (MS CCC LIC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:HOLDER
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS CCC LIC/SLP
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:JENENE
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC LIC/SLP
Mailing Address - Street 1:33 ASH ST
Mailing Address - Street 2:SCHOOL 12, SPEECH DEPARTMENT
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-1445
Mailing Address - Country:US
Mailing Address - Phone:716-816-4410
Mailing Address - Fax:
Practice Address - Street 1:118 HAMPSHIRE ST
Practice Address - Street 2:SCHOOL 18
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2014
Practice Address - Country:US
Practice Address - Phone:716-816-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008266-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist