Provider Demographics
NPI:1306449814
Name:GANGI-GAERTNER, ROSANNE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROSANNE
Middle Name:
Last Name:GANGI-GAERTNER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ROSANNE
Other - Middle Name:
Other - Last Name:GANGI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8040 LEFFERTS BLVD APT 6A
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1704
Mailing Address - Country:US
Mailing Address - Phone:917-495-4176
Mailing Address - Fax:
Practice Address - Street 1:8040 LEFFERTS BLVD APT 6A
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1704
Practice Address - Country:US
Practice Address - Phone:917-495-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist