Healthcare Provider Details

I. General information

NPI: 1730320029
Provider Name (Legal Business Name): NICOLE CHRISTINE GASPARO MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 RUSTIC WAY
FREEHOLD NJ
07728-9011
US

IV. Provider business mailing address

80 RUSTIC WAY
FREEHOLD NJ
07728-9011
US

V. Phone/Fax

Practice location:
  • Phone: 732-409-1490
  • Fax: 732-866-4305
Mailing address:
  • Phone: 732-409-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number011216
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: