Provider Demographics
NPI:1710328117
Name:GAGICH, MEREDITH KATHLEEN (MA)
Entity Type:Individual
Prefix:MISS
First Name:MEREDITH
Middle Name:KATHLEEN
Last Name:GAGICH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 HUMBOLDT ST
Mailing Address - Street 2:APARTMENT D
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-4166
Mailing Address - Country:US
Mailing Address - Phone:724-747-3806
Mailing Address - Fax:
Practice Address - Street 1:1630 HUMBOLDT ST
Practice Address - Street 2:APARTMENT D
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-4166
Practice Address - Country:US
Practice Address - Phone:724-747-3807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist