Provider Demographics
NPI:1508101288
Name:GUTIERREZ, ANA MARIA (MS, SLP)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 RACQUET CLUB RD
Mailing Address - Street 2:APT 206
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1125
Mailing Address - Country:US
Mailing Address - Phone:305-726-8663
Mailing Address - Fax:
Practice Address - Street 1:16200 EMERALD COVE RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3131
Practice Address - Country:US
Practice Address - Phone:305-985-6122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13387235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist