Provider Demographics
NPI:1609547892
Name:GUILLEN, MARIA IVONNE (HIS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:IVONNE
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-3029
Mailing Address - Country:US
Mailing Address - Phone:417-624-5800
Mailing Address - Fax:
Practice Address - Street 1:1130 W 4TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-3029
Practice Address - Country:US
Practice Address - Phone:417-624-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist