Provider Demographics
NPI:1619464401
Name:ALVAREZ, GLORIA MICHELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:MICHELLE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 N QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-3674
Mailing Address - Country:US
Mailing Address - Phone:703-228-6065
Mailing Address - Fax:
Practice Address - Street 1:1415 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4739
Practice Address - Country:US
Practice Address - Phone:703-228-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist