Provider Demographics
NPI:1023144169
Name:GIMBERLEIN, ALISON A (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:A
Last Name:GIMBERLEIN
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 1:14 IVY ST
Mailing Address - Street 2:6A
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2355
Mailing Address - Country:US
Mailing Address - Phone:631-816-1089
Mailing Address - Fax:
Practice Address - Street 1:10 JAMES ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2808
Practice Address - Country:US
Practice Address - Phone:631-669-8255
Practice Address - Fax:631-321-6645
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014026-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist