Provider Demographics
NPI:1760679799
Name:FORT, BARBARA GUTOWICZ (MA)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:GUTOWICZ
Last Name:FORT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 HOLBROOK CT
Mailing Address - Street 2:UNIT 103
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-7103
Mailing Address - Country:US
Mailing Address - Phone:562-305-8971
Mailing Address - Fax:
Practice Address - Street 1:640 HOLBROOK CT
Practice Address - Street 2:UNIT 103
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-7103
Practice Address - Country:US
Practice Address - Phone:562-305-8971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist