Healthcare Provider Details

I. General information

NPI: 1508012717
Provider Name (Legal Business Name): BETTY P. GEBAUER CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 RED PINE DR
SCHENECTADY NY
12303-5512
US

IV. Provider business mailing address

5005 COLONIAL DR. SCHENECTADY
SCHENECTADY NY
12303-5365
US

V. Phone/Fax

Practice location:
  • Phone: 518-630-0480
  • Fax:
Mailing address:
  • Phone: 518-369-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number008342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: