Provider Demographics
NPI:1669501508
Name:GUEST, NICOLE GUMPERT (SPEECH THERAPIST)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:GUMPERT
Last Name:GUEST
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12514 N OAK HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-3239
Mailing Address - Country:US
Mailing Address - Phone:225-615-7692
Mailing Address - Fax:
Practice Address - Street 1:12514 N OAK HILLS PKWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-3239
Practice Address - Country:US
Practice Address - Phone:225-615-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist