Provider Demographics
NPI:1851923254
Name:GUTIERREZ2, SAMANTHA (SLP-A)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GUTIERREZ2
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7241 W CRABAPPLE DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-7217
Mailing Address - Country:US
Mailing Address - Phone:623-363-6626
Mailing Address - Fax:
Practice Address - Street 1:7241 W CRABAPPLE DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-7217
Practice Address - Country:US
Practice Address - Phone:623-363-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA122442355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant