Provider Demographics
NPI:1225420953
Name:GUTIERREZ, KEILA (MA)
Entity Type:Individual
Prefix:MS
First Name:KEILA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S LA CANADA DR STE 38
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-2663
Mailing Address - Country:US
Mailing Address - Phone:520-904-8704
Mailing Address - Fax:520-451-5110
Practice Address - Street 1:101 S LA CANADA DR STE 38
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-2663
Practice Address - Country:US
Practice Address - Phone:520-904-8704
Practice Address - Fax:520-451-5110
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ#SLP7941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist