MEDICARE: MRS. HOLLAND MICHELLE GAZAWAY M.S. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1033663737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLAND MICHELLE GAZAWAY M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	115 BONNIE LN
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-2607
Country	:	US
Telephone Number	:	903-278-8848
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 BONNIE LN
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-2607
Country	:	US
Telephone Number	:	903-278-8848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2016
Last Update Date	:	08/25/2020

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Directions to “ MRS. HOLLAND MICHELLE GAZAWAY M.S. CCC-SLP” Practice Location

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