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General NPI Number Information
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NPI Number | 1841761020
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Entity Type | Individual
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Provider Name | STEPHANIE NICOLE GABRIELCIK M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 43765 EVERGREEN WAY
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City | CALIFORNIA
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State | MD
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Zip | 20619-4199
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Country | US
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Telephone | 301-863-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 22500 IVERSON DR APT 212
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City | GREAT MILLS
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State | MD
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Zip | 20634-2504
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Country | US
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Telephone | 724-762-3867
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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 | 08940
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License Number State | MD
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