Provider Demographics
NPI:1548662877
Name:GALLON, RUDOLPH (SPEECH THERAPIST)
Entity type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:
Last Name:GALLON
Suffix:
Gender:M
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-1418
Mailing Address - Country:US
Mailing Address - Phone:302-684-4950
Mailing Address - Fax:302-684-8931
Practice Address - Street 1:1160 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-1418
Practice Address - Country:US
Practice Address - Phone:302-684-4950
Practice Address - Fax:302-684-8931
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO1-0001380235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist