Provider Demographics
NPI:1568616738
Name:GORRY, NANCY ELLEN (MS,LSP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ELLEN
Last Name:GORRY
Suffix:
Gender:F
Credentials:MS,LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2517
Mailing Address - Country:US
Mailing Address - Phone:516-437-0986
Mailing Address - Fax:
Practice Address - Street 1:90 PRIMROSE AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2517
Practice Address - Country:US
Practice Address - Phone:516-437-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist