Provider Demographics
NPI:1518489210
Name:GUTIERREZ, AMY ALEXANDRA (MS SLP INTERN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ALEXANDRA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MS SLP INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 W DALLAS ST APT 127
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4390
Mailing Address - Country:US
Mailing Address - Phone:915-525-5288
Mailing Address - Fax:
Practice Address - Street 1:2900 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-2504
Practice Address - Country:US
Practice Address - Phone:713-741-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113708235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist