Healthcare Provider Details

I. General information

NPI: 1013831239
Provider Name (Legal Business Name): ALEXIS GALLAGHER MA, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SUMMIT AVE
SUMMIT NJ
07901-2813
US

IV. Provider business mailing address

19 MARTIN RD
VERONA NJ
07044-2823
US

V. Phone/Fax

Practice location:
  • Phone: 908-598-0228
  • Fax:
Mailing address:
  • Phone: 917-514-2569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTL-5047
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: