Provider Demographics
NPI:1245577360
Name:GUTIERREZ, DORA G (SLPA, AA)
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:G
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:SLPA, AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W. CLARK RD
Mailing Address - Street 2:PO BOX 829
Mailing Address - City:CONNELL
Mailing Address - State:WA
Mailing Address - Zip Code:99326-0829
Mailing Address - Country:US
Mailing Address - Phone:509-234-9218
Mailing Address - Fax:509-234-9204
Practice Address - Street 1:1100 W. CLARK RD BOX 829
Practice Address - Street 2:
Practice Address - City:CONNELL
Practice Address - State:WA
Practice Address - Zip Code:99326-0829
Practice Address - Country:US
Practice Address - Phone:509-234-9218
Practice Address - Fax:509-234-9204
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP 60216482355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASLPA SP60219648OtherSPEECH LANGUAGE PATHOLOGY ASSISTANT CERTIFACATION