Provider Demographics
NPI:1891578993
Name:MONTICELLO, GINA M
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:MONTICELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 THRUSH LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08827-2506
Mailing Address - Country:US
Mailing Address - Phone:908-455-0859
Mailing Address - Fax:
Practice Address - Street 1:18 THRUSH LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08827-2506
Practice Address - Country:US
Practice Address - Phone:908-574-9028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist