Provider Demographics
NPI:1427281393
Name:DAUGHERTY, GAYLE MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:MARIE
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:GAYLE
Other - Middle Name:MARIE
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:745 WATER TOWER RD
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2135
Mailing Address - Country:US
Mailing Address - Phone:231-592-1061
Mailing Address - Fax:
Practice Address - Street 1:745 WATER TOWER RD
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2135
Practice Address - Country:US
Practice Address - Phone:231-592-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI01094166235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist