Provider Demographics
NPI:1710378013
Name:GALLAGHER, DENELL MARTHA (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DENELL
Middle Name:MARTHA
Last Name:GALLAGHER
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 1:3265 BIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-816-4747
Mailing Address - Fax:541-787-4011
Practice Address - Street 1:3265 BIDDLE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-816-4747
Practice Address - Fax:541-787-4011
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist