Provider Demographics
NPI:1669666897
Name:GUIBERSON, MARK M (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:GUIBERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 REMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1358
Mailing Address - Country:US
Mailing Address - Phone:970-218-6433
Mailing Address - Fax:
Practice Address - Street 1:UNC SPEECH AND AUDIOLOGY CLINIC
Practice Address - Street 2:GUNTER HALL ROOM 0330
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639
Practice Address - Country:US
Practice Address - Phone:970-351-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12009231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist