Provider Demographics
NPI:1962578203
Name:GICALE, TINA PATEL (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:PATEL
Last Name:GICALE
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 1:1023 ELMCROFT BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6015
Mailing Address - Country:US
Mailing Address - Phone:312-391-5467
Mailing Address - Fax:
Practice Address - Street 1:1023 ELMCROFT BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6015
Practice Address - Country:US
Practice Address - Phone:312-391-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007518235Z00000X
MD07923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist