MEDICARE: MRS. TONYA GAMMAGE SHORT 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	S2971	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S2971	OTHER	MS	MS DEPT. HEALTH

General Provider Information

NPI Number	:	1598946519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONYA GAMMAGE SHORT M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 1950
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-4950
Country	:	US
Telephone Number	:	662-719-9231
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 OLD HWY. 61 NORTH
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-4950
Country	:	US
Telephone Number	:	662-719-9231
Fax Number	:

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

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	11/19/2007

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Directions to “ MRS. TONYA GAMMAGE SHORT M.S., CCC-SLP” Practice Location

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