Provider Demographics
NPI:1629550959
Name:GUIDOTTI, MICHAEL J (MS, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:GUIDOTTI
Suffix:
Gender:M
Credentials:MS, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 BURNING TREE LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2411
Mailing Address - Country:US
Mailing Address - Phone:815-409-5733
Mailing Address - Fax:
Practice Address - Street 1:850 DUNHAM RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1494
Practice Address - Country:US
Practice Address - Phone:630-443-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004992235Z00000X
IL146.014791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL146.014791OtherSTATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION