Provider Demographics
NPI:1013136654
Name:GUETTLER, GABRIELLA H (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:H
Last Name:GUETTLER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 SW PERRY TER
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7938
Mailing Address - Country:US
Mailing Address - Phone:954-552-9749
Mailing Address - Fax:772-288-4308
Practice Address - Street 1:2081 SW PERRY TER
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7938
Practice Address - Country:US
Practice Address - Phone:954-552-9749
Practice Address - Fax:772-288-4308
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4856235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL884924200Medicaid
FLSA 4856OtherDEPT OF HEALTH