Doctor Name: | MRS. MARYGRACE GLEASON |
NPI Number: | 1245549385 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA,CCC/SLP |
License Number: | 005265 |
Business Practice Address: | 175 Sequams Lane Center West Islip, NY - 117954529 |
Business Phone Number: | 6316612307 |
Business Fax Number: | |
Mailing Address: | 175 Sequams Lane Ctr, WEST ISLIP |
State: | NY |
Postal Code: | 117954529 |
Phone Number: | 6316612307 |
Fax Number: | |
NPI Enumeration Date: | 10/06/2010 |
NPI Last Update Date: | 10/06/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 005265 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |