Provider Demographics
NPI:1568934081
Name:GARNER, GRACYN MICHELLE (MCD, CF-SLP)
Entity Type:Individual
Prefix:
First Name:GRACYN
Middle Name:MICHELLE
Last Name:GARNER
Suffix:
Gender:F
Credentials:MCD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 COUNTY ROAD 791
Mailing Address - Street 2:
Mailing Address - City:BROOKLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72417-8573
Mailing Address - Country:US
Mailing Address - Phone:870-219-6247
Mailing Address - Fax:
Practice Address - Street 1:220 N OAK ST
Practice Address - Street 2:
Practice Address - City:BROOKLAND
Practice Address - State:AR
Practice Address - Zip Code:72417-8923
Practice Address - Country:US
Practice Address - Phone:870-932-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist