Provider Demographics
NPI:1609223700
Name:GALLAGHER, ANN BETH
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:BETH
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:BETH
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:78 HOMESTEAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583
Mailing Address - Country:US
Mailing Address - Phone:914-723-6155
Mailing Address - Fax:
Practice Address - Street 1:78 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5837
Practice Address - Country:US
Practice Address - Phone:914-723-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00645-1235Z00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist