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NPI Code Detail

MEDICARE: ANDREA LYNN GAMBLE MA CCC-SLP

MEDICARE: ANDREA LYNN GAMBLE MA CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist003676CT

General Provider Information

NPI Number : 1922132372
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA LYNN GAMBLE MA CCC-SLP
Provider Business Mailing Address
First Line : 59 LUDLOW RD
Second Line :
City : WINDSOR
State : CT
Zip : 06095-3635
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 EMERSON DR
Second Line :
City : WINDSOR
State : CT
Zip : 06095-3204
Country : US
Telephone Number : 860-687-3239
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/08/2007

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