Provider Demographics
NPI:1982942546
Name:GUIDA, JESSICA MARIE (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:GUIDA
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:PETTIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1067 E US HIGHWAY 24
Mailing Address - Street 2:PMB 72
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-2120
Mailing Address - Country:US
Mailing Address - Phone:970-214-8113
Mailing Address - Fax:
Practice Address - Street 1:1067 E US HIGHWAY 24
Practice Address - Street 2:PMB 72
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-2120
Practice Address - Country:US
Practice Address - Phone:719-286-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1982942546Medicaid
CO1982942546Medicare UPIN
CO1982942546Medicaid
CO1982942546Medicare NSC
CO1982942546Medicare PIN