Basic Information
| Provider Information | |||||||||
| NPI: | 1912459744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EGENDOERFER | ||||||||
| FirstName: | GALE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 MURRELL RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329406700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3214267759 | ||||||||
| FaxNumber: | 3215930839 | ||||||||
| Practice Location | |||||||||
| Address1: | 134 INFIELD CT | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281178026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047996824 | ||||||||
| FaxNumber: | 7047996825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2016 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | S13248 | FL | N | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | 103K00000X | 1-17-27-636 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.