Basic Information
| Provider Information | |||||||||
| NPI: | 1902124373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GATES | ||||||||
| FirstName: | TALAYNE | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 NORRIS RD | ||||||||
| Address2: | |||||||||
| City: | BIGLERVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173079631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173524631 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1780 KENDARBREN DIRVE | ||||||||
| Address2: | |||||||||
| City: | JAMISON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154898760 | ||||||||
| FaxNumber: | 2154898766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2010 | ||||||||
| LastUpdateDate: | 05/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL009528 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.