Provider Demographics
NPI:1174901938
Name:ADAMS, GARY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4509 RIVERTON DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1451
Mailing Address - Country:US
Mailing Address - Phone:630-386-3006
Mailing Address - Fax:
Practice Address - Street 1:4250 ALAFAYA TRL
Practice Address - Street 2:SUITE 212-258
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9412
Practice Address - Country:US
Practice Address - Phone:612-405-4279
Practice Address - Fax:678-536-1141
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13683235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist