Provider Demographics
NPI:1073783528
Name:GILLIARD, MICHELLE R (MSP, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:GILLIARD
Suffix:
Gender:F
Credentials:MSP, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 SUGAR HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-7609
Mailing Address - Country:US
Mailing Address - Phone:704-231-3113
Mailing Address - Fax:704-399-0237
Practice Address - Street 1:1729 SUGAR HOLLOW DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-7609
Practice Address - Country:US
Practice Address - Phone:704-231-3113
Practice Address - Fax:704-399-0237
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist