Provider Demographics
NPI:1043656069
Name:RESTREPO, GIOVANNA (CCC-SLP, TSSLD-BE)
Entity type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:
Last Name:RESTREPO
Suffix:
Gender:F
Credentials:CCC-SLP, TSSLD-BE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CLOVER HILL DR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1604
Mailing Address - Country:US
Mailing Address - Phone:631-766-8527
Mailing Address - Fax:
Practice Address - Street 1:2212 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-3535
Practice Address - Country:US
Practice Address - Phone:212-988-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CT006142235Z00000X
NY027450-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174400000XOther Service ProvidersSpecialist