Provider Demographics
NPI:1215951975
Name:GASTECKI, BRENDA L (MA, CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
Last Name:GASTECKI
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 W PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-8818
Mailing Address - Country:US
Mailing Address - Phone:814-664-2622
Mailing Address - Fax:814-664-2622
Practice Address - Street 1:11050 W PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-8818
Practice Address - Country:US
Practice Address - Phone:814-664-2622
Practice Address - Fax:814-664-2622
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02319991Medicaid