Provider Demographics
NPI:1578764908
Name:LEVINE, GARY DREW (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DREW
Last Name:LEVINE
Suffix:
Gender:M
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 1:601 RIFE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-4919
Mailing Address - Country:US
Mailing Address - Phone:540-942-3304
Mailing Address - Fax:
Practice Address - Street 1:1101 B EAST HIGH STREET
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902
Practice Address - Country:US
Practice Address - Phone:434-984-5218
Practice Address - Fax:434-293-2041
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist