Provider Demographics
NPI:1922454578
Name:IENNA, GABRIELLA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:IENNA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 TUNLAW RD NW
Mailing Address - Street 2:UNIT 119
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-4807
Mailing Address - Country:US
Mailing Address - Phone:516-816-1649
Mailing Address - Fax:
Practice Address - Street 1:4759 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-1921
Practice Address - Country:US
Practice Address - Phone:202-349-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC000907235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist