Provider Demographics
NPI:1548326663
Name:GALLAGHER, ALICE J
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:J
Last Name:GALLAGHER
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 1:6753 MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:ARBUCKLE
Mailing Address - State:CA
Mailing Address - Zip Code:95912-9787
Mailing Address - Country:US
Mailing Address - Phone:530-214-6025
Mailing Address - Fax:
Practice Address - Street 1:6753 MARINE AVE
Practice Address - Street 2:
Practice Address - City:ARBUCKLE
Practice Address - State:CA
Practice Address - Zip Code:95912-9787
Practice Address - Country:US
Practice Address - Phone:530-214-6025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA959237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03900PGAZZZ26427Z40OtherBLUE CHIELD