Provider Demographics
NPI:1134250681
Name:GUYTON-LOUIS, TAMARA NICOLE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:NICOLE
Last Name:GUYTON-LOUIS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S. NORTHLAKE BLVD.
Mailing Address - Street 2:APT #2142
Mailing Address - City:ALATMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701
Mailing Address - Country:US
Mailing Address - Phone:407-644-6523
Mailing Address - Fax:
Practice Address - Street 1:5020 GODDARD AVE.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-299-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8060235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist