Provider Demographics
NPI:1225379506
Name:GUGGEMOS, MATTHEW (MS CCC-SLP/ACAS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GUGGEMOS
Suffix:
Gender:M
Credentials:MS CCC-SLP/ACAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 GLEN COVE MARINA RD E STE 200
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7291
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:195 GLEN COVE MARINA RD E STE 200
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7291
Practice Address - Country:US
Practice Address - Phone:707-656-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ACAS208417OtherADVANCED CERTIFIED AUTISM SPECIALIST
CA1083215792OtherITHERAPY, A SPEECH PATHOLOGY CORPORATION