Provider Demographics
NPI:1053660217
Name:GUILLORY, PHILLIP L (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:L
Last Name:GUILLORY
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SUN AVE NE STE 650
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4670
Mailing Address - Country:US
Mailing Address - Phone:505-835-6868
Mailing Address - Fax:844-410-8875
Practice Address - Street 1:100 SUN AVE NE STE 650
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-835-6868
Practice Address - Fax:844-410-8875
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist