Provider Demographics
NPI:1053537324
Name:GALLEGOS, MONICA DEANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:DEANN
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-1312
Mailing Address - Country:US
Mailing Address - Phone:817-690-7962
Mailing Address - Fax:602-305-7880
Practice Address - Street 1:711 W WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1312
Practice Address - Country:US
Practice Address - Phone:817-690-7962
Practice Address - Fax:602-305-7880
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist