Provider Demographics
NPI:1154528172
Name:BUCHNIK, GABRIELLA C (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:GABRIELLA
Middle Name:C
Last Name:BUCHNIK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 W WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2186
Mailing Address - Country:US
Mailing Address - Phone:414-540-1528
Mailing Address - Fax:
Practice Address - Street 1:10303 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5760
Practice Address - Country:US
Practice Address - Phone:262-241-5955
Practice Address - Fax:262-241-5926
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2923-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI235Z00000XOtherSPEECH PATHOLOGIST