Provider Demographics
NPI:1659781235
Name:GUICE, DAWN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:GUICE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7607 FERN AVE STE 704
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5744
Mailing Address - Country:US
Mailing Address - Phone:318-828-1450
Mailing Address - Fax:318-828-2697
Practice Address - Street 1:7607 FERN AVE STE 704
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5744
Practice Address - Country:US
Practice Address - Phone:318-828-1450
Practice Address - Fax:318-828-2697
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6201235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist