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Gwendolyn Casey Russo

Speech-Language Pathologist, in East Setauket, NY. Individual provider (NPI-1).

NPI number1144358409
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1144358409
Entity type
Individual (NPI-1)
Name
Gwendolyn Casey Russo
Sex
Female
Sole proprietor
No
Enumeration date
Mar 1, 2007
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
235Z00000X Speech-Language Pathologist,58 015581NYYes

Practice location

14 Research Way
East Setauket, NY 11733-3453

Phone 631-331-6400

Mailing address

54 Shinbone Ln
Commack, NY 11725-5517

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