Provider Demographics
NPI:1255832960
Name:GUTIERREZ, ELIZABETH A (BS ASSISTANT SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:BS ASSISTANT SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 PEACOCK DR
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-7698
Mailing Address - Country:US
Mailing Address - Phone:956-454-1428
Mailing Address - Fax:
Practice Address - Street 1:1145 ROSS ST STE K
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4338
Practice Address - Country:US
Practice Address - Phone:956-361-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330242355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant