Provider Demographics
NPI:1790930956
Name:GALLO DE OLIVA, ANDREA CAROLINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAROLINA
Last Name:GALLO DE OLIVA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:CAROLINA
Other - Last Name:GALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5425
Mailing Address - Country:US
Mailing Address - Phone:718-924-6722
Mailing Address - Fax:
Practice Address - Street 1:1604 SPRING HILL RD
Practice Address - Street 2:3TH FLOOR, SUITE 310
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7510
Practice Address - Country:US
Practice Address - Phone:703-546-8594
Practice Address - Fax:212-679-7867
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist