Provider Demographics
NPI:1114543212
Name:GUZMAN, KEILA (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:KEILA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DELLORO ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1200
Mailing Address - Country:US
Mailing Address - Phone:845-709-2357
Mailing Address - Fax:
Practice Address - Street 1:101 STAGE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3512
Practice Address - Country:US
Practice Address - Phone:845-827-6227
Practice Address - Fax:845-827-6228
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist