Healthcare Provider Details

I. General information

NPI: 1679031744
Provider Name (Legal Business Name): ANNABELL PEREZ GWIAZDOSKI M.S. CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 PARK RD STE 201
WEST HARTFORD CT
06119-2017
US

IV. Provider business mailing address

312 PARK RD STE 201
WEST HARTFORD CT
06119-2017
US

V. Phone/Fax

Practice location:
  • Phone: 860-523-9790
  • Fax: 860-523-1277
Mailing address:
  • Phone: 860-523-9790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number003319
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: