Healthcare Provider Details

I. General information

NPI: 1942717277
Provider Name (Legal Business Name): DEEANN GUYMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13385 W. MCDOWELL ROAD
GOODYEAR AZ
85395
US

IV. Provider business mailing address

600 S 178TH LN
GOODYEAR AZ
85338-4628
US

V. Phone/Fax

Practice location:
  • Phone: 623-986-5110
  • Fax:
Mailing address:
  • Phone: 623-221-7758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA10838
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: