=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245054907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH KHRISTINE GAJDA M.ED., ED.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2024
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 770 BROWNHOME RD
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16101-8312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-842-2160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 770 BROWNHOME RD
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16101-8312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-842-2160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | OH1435006
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------