Provider Demographics
NPI:1912171232
Name:GUE, YVETTE MICKAYLLA
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:MICKAYLLA
Last Name:GUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-8894
Mailing Address - Country:US
Mailing Address - Phone:803-536-5555
Mailing Address - Fax:
Practice Address - Street 1:748 HICKORY HILL RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-8894
Practice Address - Country:US
Practice Address - Phone:803-536-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2878235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist