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General NPI Number Information
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NPI Number | 1154787372
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Entity Type | Organization
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Legal Business Name | GIFT OF GAB,LLC
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 172 MOUNT PLEASANT RD
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City | NEWTOWN
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State | CT
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Zip | 06470-1443
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Country | US
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Telephone | 203-725-7729
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Fax |
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Provider Business Mailing Address
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Address Line | 108 COUNTRY WOODS LN
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City | SOUTHBURY
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State | CT
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Zip | 06488-1297
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Country | US
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Telephone | 203-725-7729
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MIA DECATO RAMEY
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Credential | CCC-SLP
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Telephone | 203-725-7729
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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 | 003923
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License Number State | CT
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