Provider Demographics
NPI:1104491125
Name:OUTLAND, GARRETT (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:OUTLAND
Suffix:
Gender:M
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 1:4641 GULFSTARR DR STE 102
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3776
Mailing Address - Country:US
Mailing Address - Phone:850-964-6162
Mailing Address - Fax:
Practice Address - Street 1:4641 GULFSTARR DR STE 102
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541
Practice Address - Country:US
Practice Address - Phone:850-964-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-3517235Z00000X
MESP3946235Z00000X
CA35099235Z00000X
VA2202010958235Z00000X
IL146016774235Z00000X
FLSA20348235Z00000X
NJ41YS01202600235Z00000X
COSLP.0005540235Z00000X
PASL017036235Z00000X
AK210009235Z00000X
AL5303235Z00000X
TX120579235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty