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General NPI Number Information
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NPI Number | 1063784742
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Entity Type | Individual
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Provider Name | AGNES M GAVIN M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 126 LAKE AVE LAKE AVENUE ELEMENTARY SCHOOL
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2431
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Country | US
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Telephone | 518-584-3678
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Fax |
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Provider Business Mailing Address
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Address Line | 8 LAURA LN
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-8782
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Country | US
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Telephone | 518-583-6837
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 012719-1
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License Number State | NY
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