Provider Demographics
NPI:1710668785
Name:DICARLO, GINA (SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DICARLO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 RTE 51N
Mailing Address - Street 2:
Mailing Address - City:ROSTRAVER TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15012-3535
Mailing Address - Country:US
Mailing Address - Phone:724-565-5806
Mailing Address - Fax:724-483-0290
Practice Address - Street 1:625 LINCOLN AVE STE 107
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-2451
Practice Address - Country:US
Practice Address - Phone:724-483-4886
Practice Address - Fax:724-483-0519
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016802235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist