Provider Demographics
NPI:1669627741
Name:GUZYK, TISHUBA D (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TISHUBA
Middle Name:D
Last Name:GUZYK
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 UPPER STELLA IRELAND RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-5934
Mailing Address - Country:US
Mailing Address - Phone:607-770-0816
Mailing Address - Fax:
Practice Address - Street 1:320 UPPER STELLA IRELAND RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-5934
Practice Address - Country:US
Practice Address - Phone:607-770-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010404-3235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist