Provider Demographics
NPI:1578203832
Name:GALLO, DEIDRE W (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:W
Last Name:GALLO
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 1:212 PINE TREE LN
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2028
Mailing Address - Country:US
Mailing Address - Phone:732-822-3733
Mailing Address - Fax:
Practice Address - Street 1:716 N BETHLEHEM PIKE STE 103
Practice Address - Street 2:
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-2656
Practice Address - Country:US
Practice Address - Phone:267-652-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA5240593235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist