Provider Demographics
NPI:1558791764
Name:GUY, BERNADETTE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:GUY
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 1:320 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3402
Mailing Address - Country:US
Mailing Address - Phone:937-496-6200
Mailing Address - Fax:
Practice Address - Street 1:9450 TAHOE DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-3689
Practice Address - Country:US
Practice Address - Phone:937-671-9069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP4978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist