Provider Demographics
NPI:1629549969
Name:GUTIERREZ, ROXANNE ALLYCE (BA, SLP-ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:ALLYCE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:BA, SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 WHEELHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5828
Mailing Address - Country:US
Mailing Address - Phone:832-879-0071
Mailing Address - Fax:
Practice Address - Street 1:614 WHEELHOUSE DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5828
Practice Address - Country:US
Practice Address - Phone:832-879-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374422355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37442OtherSTATE OF TEXAS