Healthcare Provider Details

I. General information

NPI: 1427358779
Provider Name (Legal Business Name): MRS. KRISTA LYNN GALELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTA LYNN RENZI

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 TAMARA DR
OLD FORGE PA
18518-2341
US

IV. Provider business mailing address

102 TAMARA DR
OLD FORGE PA
18518-2341
US

V. Phone/Fax

Practice location:
  • Phone: 570-212-2659
  • Fax:
Mailing address:
  • Phone: 570-212-2659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL009783
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: