Provider Demographics
NPI:1841343597
Name:GUERRA, DANA GREMILLION (MCD)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:GREMILLION
Last Name:GUERRA
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9947 JON BOAT WAY
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-5366
Mailing Address - Country:US
Mailing Address - Phone:504-975-3710
Mailing Address - Fax:
Practice Address - Street 1:746 ALPINE DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2502
Practice Address - Country:US
Practice Address - Phone:504-975-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5656235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist