Provider Demographics
NPI:1689708067
Name:GAUR, MICHELE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:GAUR
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 DWYER ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-1920
Mailing Address - Country:US
Mailing Address - Phone:901-340-4975
Mailing Address - Fax:901-248-6892
Practice Address - Street 1:940 DWYER ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-1920
Practice Address - Country:US
Practice Address - Phone:901-340-4975
Practice Address - Fax:901-248-6892
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP0000001732235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist