Provider Demographics
NPI:1912219882
Name:PUCCIO, GIANNA M (M)
Entity Type:Individual
Prefix:MS
First Name:GIANNA
Middle Name:M
Last Name:PUCCIO
Suffix:
Gender:F
Credentials:M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 N LINDSAY RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5807
Mailing Address - Country:US
Mailing Address - Phone:480-632-2757
Mailing Address - Fax:480-632-1504
Practice Address - Street 1:33 N LINDSAY RD
Practice Address - Street 2:SUITE 111
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5807
Practice Address - Country:US
Practice Address - Phone:480-632-2757
Practice Address - Fax:480-632-1504
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP6757235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist