Provider Demographics
NPI:1346691060
Name:GUTIERREZ, JOANNA (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S. HIGHPOINT DR
Mailing Address - Street 2:APT 203
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-4902
Mailing Address - Country:US
Mailing Address - Phone:815-508-7703
Mailing Address - Fax:
Practice Address - Street 1:122 HIGHPOINT DR
Practice Address - Street 2:APT. 203
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-4902
Practice Address - Country:US
Practice Address - Phone:815-508-7703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.003748235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist