Provider Demographics
NPI:1063610509
Name:FINCH, GINA NICOLE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:NICOLE
Last Name:FINCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 STONEBROOK
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-2809
Mailing Address - Country:US
Mailing Address - Phone:573-614-1401
Mailing Address - Fax:
Practice Address - Street 1:2402 STONEBROOK
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2809
Practice Address - Country:US
Practice Address - Phone:573-614-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist