Individual
MRS. TONYA GAMMAGE SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
1111 OLD HWY. 61 NORTH, CLEVELAND, MS 38732-4950
(662) 719-9231
Mailing address
PO BOX 1950, CLEVELAND, MS 38732-4950
(662) 719-9231
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
S2971
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S2971
MS DEPT. HEALTH
MS
Enumeration date
11/19/2007
Last updated
11/19/2007
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