Provider Demographics
NPI:1821223744
Name:GAGLIOLO, ALISON MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:MARIE
Last Name:GAGLIOLO
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 1:2165 73RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5917
Mailing Address - Country:US
Mailing Address - Phone:347-525-5373
Mailing Address - Fax:
Practice Address - Street 1:2165 73RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5917
Practice Address - Country:US
Practice Address - Phone:347-525-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist