Provider Demographics
NPI:1609885599
Name:GEHAN, MICHAEL PETER (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
Last Name:GEHAN
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 W PARKER RD
Mailing Address - Street 2:278-196
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7767
Mailing Address - Country:US
Mailing Address - Phone:972-608-0416
Mailing Address - Fax:972-608-0430
Practice Address - Street 1:5928 W PARKER RD
Practice Address - Street 2:1000
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6433
Practice Address - Country:US
Practice Address - Phone:972-608-0416
Practice Address - Fax:972-608-0430
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51347231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144706202Medicaid
TX528498OtherBLUE CROSS BLUE SHILED
TX7570709OtherAETNA
TX580066Medicare PIN
TX528498OtherBLUE CROSS BLUE SHILED