Healthcare Provider Details

I. General information

NPI: 1407269814
Provider Name (Legal Business Name): ANDRIA GUTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 W PIONEER PKWY SUITE 1126
ARLINGTON TX
76013-6367
US

IV. Provider business mailing address

305 NE LOOP 280 BUSINESS TOWER1;SUITE 200
HURST TX
76053
US

V. Phone/Fax

Practice location:
  • Phone: 817-795-1291
  • Fax: 817-462-5071
Mailing address:
  • Phone: 817-292-8787
  • Fax: 817-789-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number38376
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: