Provider Demographics
NPI:1700422052
Name:GUY, WANDA D (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:D
Last Name:GUY
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24208 S LAKESIDE TRL
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1821
Mailing Address - Country:US
Mailing Address - Phone:708-672-6145
Mailing Address - Fax:
Practice Address - Street 1:24208 S LAKESIDE TRL
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-1821
Practice Address - Country:US
Practice Address - Phone:708-672-6145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist