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General NPI Number Information
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NPI Number | 1902764764
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Entity Type | Individual
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Provider Name | GABRIELLE ELAINE PHILYAW
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Gender | Female
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 3432 JEFFERSON AVE
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City | TEXARKANA
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State | AR
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Zip | 71854-2747
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Country | US
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Telephone | 870-330-3088
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Fax |
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Provider Business Mailing Address
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Address Line | 103 SHERWOOD CT
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City | DIERKS
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State | AR
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Zip | 71833-9556
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 203399
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License Number State | AR
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