Provider Demographics
NPI:1538282595
Name:FITZGIBBONS, GREGORY ALAN (MA CCC-A)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALAN
Last Name:FITZGIBBONS
Suffix:
Gender:M
Credentials:MA CCC-A
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Other - First Name:
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Mailing Address - Street 1:1776 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3190
Mailing Address - Country:US
Mailing Address - Phone:925-933-2699
Mailing Address - Fax:
Practice Address - Street 1:1776 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3190
Practice Address - Country:US
Practice Address - Phone:925-933-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1737231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17989ZMedicare ID - Type Unspecified