Provider Demographics
NPI:1508975137
Name:GUILLOTTE, AMANDA HAMMON (AUD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:HAMMON
Last Name:GUILLOTTE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 PINE CONE DR
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-2353
Mailing Address - Country:US
Mailing Address - Phone:228-218-1373
Mailing Address - Fax:
Practice Address - Street 1:3017 13TH ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-1833
Practice Address - Country:US
Practice Address - Phone:228-863-6592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA2920231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist