Most Relevant Information
Provider Data
| NPI Number: | 1003072869 |
| Provider Name: | GRETCHEN GUSTAVSON M.S., CCC-SLP |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 014227 |
Most Important Dates
| Enumeration Date: | 07/31/2008 |
| Last Updated: | 07/31/2008 |
Provider Practice Location
149 N MAIN ST
FAIRPORT
NY
144501434
Practice Location Phone/Fax
| Phone: | 5853772230 |
| Fax: |
Provider Mailing Location
83 DARTMOUTH ST APT 3
ROCHESTER
NY
146072826
Provider Mailing Phone/Fax
| Phone: | 5857492666 |
| Fax: |