Healthcare Provider Details

I. General information

NPI: 1033356761
Provider Name (Legal Business Name): LG INTERVENTION SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 ST. JOHNS ROAD
DRUMS PA
18222-1803
US

IV. Provider business mailing address

773 ST. JOHNS ROAD
DRUMS PA
18222-1803
US

V. Phone/Fax

Practice location:
  • Phone: 570-788-8320
  • Fax:
Mailing address:
  • Phone: 570-788-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: LAURENE SUSAN GABRIEL
Title or Position: PRESIDENT
Credential: MS, CCC-SLP
Phone: 570-788-8320