Provider Demographics
NPI:1629229562
Name:GALLO, ELIZABETH CATHERINE (SLP)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:CATHERINE
Last Name:GALLO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-4408
Mailing Address - Country:US
Mailing Address - Phone:631-275-1411
Mailing Address - Fax:
Practice Address - Street 1:272 PHELPS LN
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-4006
Practice Address - Country:US
Practice Address - Phone:631-275-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist