Provider Demographics
NPI:1972814986
Name:GALLARDO, JERICA MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JERICA
Middle Name:MARIE
Last Name:GALLARDO
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 1:850 N MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1822
Mailing Address - Country:US
Mailing Address - Phone:913-575-1488
Mailing Address - Fax:
Practice Address - Street 1:850 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1822
Practice Address - Country:US
Practice Address - Phone:913-575-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2997235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist