1730689860 NPI number — CHELSEA GAGLIO M.S., CCC-SLP

Table of content: CHELSEA GAGLIO M.S., CCC-SLP (NPI 1730689860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730689860 NPI number — CHELSEA GAGLIO M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAGLIO
Provider First Name:
CHELSEA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730689860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1931 BLACK ROCK TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06825-3506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-384-8681
Provider Business Mailing Address Fax Number:
203-384-0722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 BOSTON POST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06460-2684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-783-1997
Provider Business Practice Location Address Fax Number:
203-783-3997
Provider Enumeration Date:
02/15/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  5365 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)