Provider Demographics
NPI:1235877994
Name:GUILLOTTE, MACY BELL
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:BELL
Last Name:GUILLOTTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 FRANK DR
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71049-3028
Mailing Address - Country:US
Mailing Address - Phone:318-560-3746
Mailing Address - Fax:
Practice Address - Street 1:201 CROSBY ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-2613
Practice Address - Country:US
Practice Address - Phone:318-872-2836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist