Provider Demographics
NPI:1598056970
Name:GUTIERREZ, LAINE ANNE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAINE
Middle Name:ANNE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:LAINE
Other - Middle Name:ANNE
Other - Last Name:OKULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:287 SOUTHERN FARM RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8100
Mailing Address - Country:US
Mailing Address - Phone:419-203-0727
Mailing Address - Fax:773-897-4112
Practice Address - Street 1:6911 SHANNON WILLOW RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-1346
Practice Address - Country:US
Practice Address - Phone:704-540-3777
Practice Address - Fax:704-540-1443
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist