Provider Demographics
NPI:1881885606
Name:GUTSTADT, BARBARA JO (BS,CEA)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JO
Last Name:GUTSTADT
Suffix:
Gender:F
Credentials:BS,CEA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 HARBOUR YACHT CT
Mailing Address - Street 2:C
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-1150
Mailing Address - Country:US
Mailing Address - Phone:239-823-0904
Mailing Address - Fax:239-433-5977
Practice Address - Street 1:11150 HARBOUR YACHT CT
Practice Address - Street 2:C
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-1150
Practice Address - Country:US
Practice Address - Phone:239-823-0904
Practice Address - Fax:239-433-5977
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist