Provider Demographics
NPI:1083878052
Name:MCCOY, GAYLA ELAINE (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:GAYLA
Middle Name:ELAINE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 STERLING WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7546
Mailing Address - Country:US
Mailing Address - Phone:270-282-1363
Mailing Address - Fax:
Practice Address - Street 1:86 STERLING WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7546
Practice Address - Country:US
Practice Address - Phone:270-282-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2309OtherSPEECH PATHOLOGY LICENSE