MEDICARE: GABRIELLE ELAINE PHILYAW

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	2355S0801X	Speech-Language Assistant	203399	AR

General Provider Information

NPI Number	:	1902764764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE ELAINE PHILYAW

Provider Business Mailing Address
First Line	:	103 SHERWOOD CT
Second Line	:
City	:	DIERKS
State	:	AR
Zip	:	71833-9556
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3432 JEFFERSON AVE
Second Line	:
City	:	TEXARKANA
State	:	AR
Zip	:	71854-2747
Country	:	US
Telephone Number	:	870-330-3088
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ GABRIELLE ELAINE PHILYAW ” Practice Location

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