Healthcare Provider Details

I. General information

NPI: 1174441265
Provider Name (Legal Business Name): DIANA GUADALUPE GUTIERREZ SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S HIGLEY RD STE 103-477
GILBERT AZ
85296-1166
US

IV. Provider business mailing address

14012 N 34TH PL
PHOENIX AZ
85032-5309
US

V. Phone/Fax

Practice location:
  • Phone: 480-998-1477
  • Fax:
Mailing address:
  • Phone: 602-334-6199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: