Provider Demographics
NPI:1609563253
Name:GALLAGHER, LAURA LILLIAN (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LILLIAN
Last Name:GALLAGHER
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 1:5 WINDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-1821
Mailing Address - Country:US
Mailing Address - Phone:914-329-9217
Mailing Address - Fax:
Practice Address - Street 1:5 WINDWOOD RD
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-1821
Practice Address - Country:US
Practice Address - Phone:914-329-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00503200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist