Provider Demographics
NPI:1013516418
Name:GUTIERREZ, GABRIELLE ALEXIS (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ALEXIS
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45077 RIVERSIDE EST
Mailing Address - Street 2:
Mailing Address - City:SAINT AMANT
Mailing Address - State:LA
Mailing Address - Zip Code:70774-4212
Mailing Address - Country:US
Mailing Address - Phone:225-328-2358
Mailing Address - Fax:
Practice Address - Street 1:821 N BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2835
Practice Address - Country:US
Practice Address - Phone:225-939-7205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist