Provider Demographics
NPI:1689121600
Name:GUTIERREZ, DEBORAH (HIS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:MANROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HIS
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:405 N BEAVER ST
Practice Address - Street 2:STE 4
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4500
Practice Address - Country:US
Practice Address - Phone:928-214-0907
Practice Address - Fax:928-222-0008
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHADE9823237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist