Provider Demographics
NPI:1205093788
Name:LAMBIE, GINA DRAGOTTA (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:DRAGOTTA
Last Name:LAMBIE
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 S 16TH ST
Mailing Address - Street 2:ACUTE REHAB
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4526
Mailing Address - Country:US
Mailing Address - Phone:414-647-7422
Mailing Address - Fax:
Practice Address - Street 1:3237 S 16TH ST
Practice Address - Street 2:ACUTE REHAB
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4526
Practice Address - Country:US
Practice Address - Phone:414-647-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1401-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1401-154OtherSTATE OF WISCONSIN DEPT OF REG AND LICENSING