Provider Demographics
NPI:1922246461
Name:GUAJARDO, GUADALUPE III (BS ASST SLP)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:GUAJARDO
Suffix:III
Gender:M
Credentials:BS ASST SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2912
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-2912
Mailing Address - Country:US
Mailing Address - Phone:956-648-3910
Mailing Address - Fax:
Practice Address - Street 1:3616 JOBY ST APT 1
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-6141
Practice Address - Country:US
Practice Address - Phone:956-648-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344102355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant