Provider Demographics
NPI:1417101650
Name:GUTIERREZ, ADRIANA (MA, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MS
First Name:ADRIANA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5370
Mailing Address - Country:US
Mailing Address - Phone:718-706-4660
Mailing Address - Fax:
Practice Address - Street 1:4608 5TH ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5370
Practice Address - Country:US
Practice Address - Phone:718-706-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018667-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist