Provider Demographics
NPI:1780936914
Name:GADELL, AMY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:GADELL
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 1:1871 THURSTON DR
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-9613
Mailing Address - Country:US
Mailing Address - Phone:540-204-2447
Mailing Address - Fax:
Practice Address - Street 1:1871 THURSTON DR
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-9613
Practice Address - Country:US
Practice Address - Phone:540-204-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist