Provider Demographics
NPI:1467804526
Name:GUPTILL, BRIANA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:GUPTILL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 BASIE WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7328
Mailing Address - Country:US
Mailing Address - Phone:209-712-9526
Mailing Address - Fax:
Practice Address - Street 1:6550 LONETREE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5874
Practice Address - Country:US
Practice Address - Phone:916-778-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2024-04-12
Deactivation Date:2020-07-24
Deactivation Code:
Reactivation Date:2024-04-12
Provider Licenses
StateLicense IDTaxonomies
CAST22325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22325OtherCA SLP BOARD