Provider Demographics
NPI:1922038397
Name:PILLOW, GARY (EDD, AUD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:PILLOW
Suffix:
Gender:M
Credentials:EDD, AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1542
Mailing Address - Country:US
Mailing Address - Phone:540-968-0100
Mailing Address - Fax:540-862-6749
Practice Address - Street 1:283 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1542
Practice Address - Country:US
Practice Address - Phone:540-968-0100
Practice Address - Fax:540-862-6749
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV(WVDE) 2173235Z00000X
VA2202002014235Z00000X
WVA-0204237600000X
VA2101000348237700000X
VA2201000161231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009450807Medicaid