Provider Demographics
NPI:1548289408
Name:GRAMIGNA, GARY D (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:D
Last Name:GRAMIGNA
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 VFW PKWY
Mailing Address - Street 2:(126)
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4927
Mailing Address - Country:US
Mailing Address - Phone:857-203-6776
Mailing Address - Fax:857-203-5507
Practice Address - Street 1:1400 VFW PKWY
Practice Address - Street 2:(126)
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4927
Practice Address - Country:US
Practice Address - Phone:857-203-6776
Practice Address - Fax:857-203-5507
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist