Provider Demographics
NPI:1629384359
Name:GATTA, JANICE E (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:E
Last Name:GATTA
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 1:1 ANITA DR
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2801
Mailing Address - Country:US
Mailing Address - Phone:631-567-1617
Mailing Address - Fax:
Practice Address - Street 1:1 ANITA DR
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2801
Practice Address - Country:US
Practice Address - Phone:631-567-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001074-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist