Provider Demographics
NPI:1386034494
Name:GUTIERREZ, JENNIFER MARIE (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:GILLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:17108 PONCHO SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-2964
Mailing Address - Country:US
Mailing Address - Phone:512-299-8295
Mailing Address - Fax:
Practice Address - Street 1:5750 BALCONES DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4252
Practice Address - Country:US
Practice Address - Phone:512-836-8786
Practice Address - Fax:512-836-8794
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51334231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist