Provider Demographics
NPI:1972924306
Name:GUTHRIE, KELLIE LYNN (MED, CFY-SLP)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:LYNN
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:MED, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BAYTREE RD STE C
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2881
Mailing Address - Country:US
Mailing Address - Phone:229-253-1009
Mailing Address - Fax:229-253-1039
Practice Address - Street 1:701 BAYTREE RD STE C
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2881
Practice Address - Country:US
Practice Address - Phone:229-253-1009
Practice Address - Fax:229-253-1039
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET002000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist