Provider Demographics
NPI:1912373259
Name:GUIDER, ANDREA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:GUIDER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CF-SLP
Mailing Address - Street 1:1256 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-6077
Mailing Address - Country:US
Mailing Address - Phone:740-657-4700
Mailing Address - Fax:
Practice Address - Street 1:1256 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-6077
Practice Address - Country:US
Practice Address - Phone:740-657-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND2016062235Z00000X
OHSP.12140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist