Healthcare Provider Details

I. General information

NPI: 1134250681
Provider Name (Legal Business Name): TAMARA NICOLE GUYTON-LOUIS M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 GODDARD AVE.
ORLANDO FL
32804
US

IV. Provider business mailing address

321 S. NORTHLAKE BLVD. APT #2142
ALATMONTE SPRINGS FL
32701
US

V. Phone/Fax

Practice location:
  • Phone: 407-299-1533
  • Fax:
Mailing address:
  • Phone: 407-644-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA8060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: