Healthcare Provider Details

I. General information

NPI: 1366028003
Provider Name (Legal Business Name): CODY GALLAGHER CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 INDIAN RIVER RD
ORANGE CT
06477-3634
US

IV. Provider business mailing address

12 OVERHILL RD
MILFORD CT
06460-7227
US

V. Phone/Fax

Practice location:
  • Phone: 855-428-8246
  • Fax: 855-428-8246
Mailing address:
  • Phone: 203-988-3042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number008510
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: