Provider Demographics
NPI:1477001212
Name:GOWEN, MICHELLE (MS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GOWEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 HYDRANGEA DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3703
Mailing Address - Country:US
Mailing Address - Phone:631-525-7099
Mailing Address - Fax:
Practice Address - Street 1:8703 HIGHWAY 17 BYP S
Practice Address - Street 2:SUITE 1
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-7701
Practice Address - Country:US
Practice Address - Phone:843-457-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist