Provider Demographics
NPI:1912508326
Name:WARREN, GINA (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 MAIN ST UNIT 314
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1772
Mailing Address - Country:US
Mailing Address - Phone:315-506-5982
Mailing Address - Fax:
Practice Address - Street 1:5460 MELTZER CT
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9430
Practice Address - Country:US
Practice Address - Phone:315-506-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030312235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist