Provider Demographics
NPI:1437693538
Name:GUAQUETA-TYLER, NATALIA (MA/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:GUAQUETA-TYLER
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:GUAQUETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA/CCC-SLP
Mailing Address - Street 1:62 KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:62 KIMBERLY DR
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4210
Practice Address - Country:US
Practice Address - Phone:530-321-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2578235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESP2578Medicaid