Provider Demographics
NPI:1871736934
Name:GAGNON, BERNADINE RAE (MS)
Entity type:Individual
Prefix:MS
First Name:BERNADINE
Middle Name:RAE
Last Name:GAGNON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 W 110TH ST
Mailing Address - Street 2:APT. #7-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2637
Mailing Address - Country:US
Mailing Address - Phone:212-678-3889
Mailing Address - Fax:
Practice Address - Street 1:352 W 110TH ST
Practice Address - Street 2:APT. #7-C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-2637
Practice Address - Country:US
Practice Address - Phone:212-678-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-19
Last Update Date:2009-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013892-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist