Provider Demographics
NPI:1639617194
Name:DEDE, GAYLE
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:DEDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 MAIN ST
Mailing Address - Street 2:502
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-2100
Mailing Address - Country:US
Mailing Address - Phone:215-204-2453
Mailing Address - Fax:
Practice Address - Street 1:1701 N 13TH ST RM 110
Practice Address - Street 2:DEPT OF COMMUNICATION SCIENCES AND DISORDERS, TEMPLE U
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-6011
Practice Address - Country:US
Practice Address - Phone:215-204-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012599235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist