Provider Demographics
NPI:1700383361
Name:GABRIELA ANTAO SLP LLC
Entity Type:Organization
Organization Name:GABRIELA ANTAO SLP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:GARGANTA
Authorized Official - Last Name:ANTAO
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:908-720-6074
Mailing Address - Street 1:4011 BIG HORN RD # 6H
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-4995
Mailing Address - Country:US
Mailing Address - Phone:908-720-6074
Mailing Address - Fax:
Practice Address - Street 1:4011 BIG HORN RD # 6H
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-4995
Practice Address - Country:US
Practice Address - Phone:908-720-6074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0001692235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty