Provider Demographics
NPI:1619731403
Name:PINES, GABRIELLE IRINA
Entity type:Individual
Prefix:MISS
First Name:GABRIELLE
Middle Name:IRINA
Last Name:PINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 E LEGACY BLVD UNIT P4003
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6546
Mailing Address - Country:US
Mailing Address - Phone:860-977-4005
Mailing Address - Fax:
Practice Address - Street 1:8045 N 47TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-6402
Practice Address - Country:US
Practice Address - Phone:623-435-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA150012355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant