Provider Demographics
NPI:1932409109
Name:ZACK, GABRIELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:GABRIELLE
Middle Name:
Last Name:ZACK
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 1:608 MONROE ST
Mailing Address - Street 2:APT. 2B
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6366
Mailing Address - Country:US
Mailing Address - Phone:631-807-2768
Mailing Address - Fax:
Practice Address - Street 1:608 MONROE ST
Practice Address - Street 2:APT. 2B
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6366
Practice Address - Country:US
Practice Address - Phone:631-807-2768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00630200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist