Provider Demographics
NPI:1841425535
Name:GALLAGHER, AMY (MA,CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SHORE DRIVE
Mailing Address - Street 2:F-7
Mailing Address - City:HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07732
Mailing Address - Country:US
Mailing Address - Phone:732-991-0685
Mailing Address - Fax:
Practice Address - Street 1:330 SHORE DR
Practice Address - Street 2:F-7
Practice Address - City:HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07732-1145
Practice Address - Country:US
Practice Address - Phone:732-991-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-25
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00335000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist