Provider Demographics
NPI:1780645085
Name:GUY, BECKY LYNN (MA)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:LYNN
Last Name:GUY
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 1:12108 OLD LINE CTR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2553
Mailing Address - Country:US
Mailing Address - Phone:301-638-3440
Mailing Address - Fax:301-638-3442
Practice Address - Street 1:3475 LEONARDTOWN RD STE 102
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3678
Practice Address - Country:US
Practice Address - Phone:301-374-8477
Practice Address - Fax:301-374-8432
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00710231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD780LE407Medicare ID - Type Unspecified