Provider Demographics
NPI:1962922625
Name:GAVLOCK, ANNA HELEN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:HELEN
Last Name:GAVLOCK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:HELEN
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2235 MILLERSPORT HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068
Mailing Address - Country:US
Mailing Address - Phone:716-810-7000
Mailing Address - Fax:
Practice Address - Street 1:2235 MILLERSPORT HIGHWAY
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068
Practice Address - Country:US
Practice Address - Phone:716-810-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist