Provider Demographics
NPI:1588085708
Name:GILLIGAN, GERIANNE MULDOON (PHD)
Entity type:Individual
Prefix:
First Name:GERIANNE
Middle Name:MULDOON
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 N POWHATAN ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1139
Mailing Address - Country:US
Mailing Address - Phone:703-229-2043
Mailing Address - Fax:
Practice Address - Street 1:2430 N POWHATAN ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1139
Practice Address - Country:US
Practice Address - Phone:703-229-2043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005115235Z00000X
FLSA-5349235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist