Provider Demographics
NPI:1316439458
Name:GUNN, MIRANDA GIVENS (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:GIVENS
Last Name:GUNN
Suffix:
Gender:F
Credentials:MS CCC-SLP
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Mailing Address - Street 1:935 FAIRYSTONE PARK HWY
Mailing Address - Street 2:
Mailing Address - City:STANLEYTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:24168-3014
Mailing Address - Country:US
Mailing Address - Phone:276-622-3636
Mailing Address - Fax:276-627-0060
Practice Address - Street 1:935 FAIRYSTONE PARK HWY
Practice Address - Street 2:
Practice Address - City:STANLEYTOWN
Practice Address - State:VA
Practice Address - Zip Code:24168-3014
Practice Address - Country:US
Practice Address - Phone:276-622-3636
Practice Address - Fax:276-627-0060
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
235Z00000X
VA2202008563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist