Provider Demographics
NPI:1679158794
Name:CARDONA, GABRIELA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:CARDONA
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 1:32 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3957
Mailing Address - Country:US
Mailing Address - Phone:207-776-3288
Mailing Address - Fax:
Practice Address - Street 1:22 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1318
Practice Address - Country:US
Practice Address - Phone:207-776-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP3431235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist