Healthcare Provider Details

I. General information

NPI: 1013830801
Provider Name (Legal Business Name): MEGAN MIRANDA GAGE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2386
US

IV. Provider business mailing address

2515 ORCHARD CIRCLE DR APT 17
TRAVERSE CITY MI
49686-1590
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-5000
  • Fax:
Mailing address:
  • Phone: 231-590-9208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: