Healthcare Provider Details

I. General information

NPI: 1962707109
Provider Name (Legal Business Name): NORA GUTIERREZ MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N. BUSINESS 1015
PROGRESO TX
78579
US

IV. Provider business mailing address

P.O. BOX 610
PROGRESO TX
78579
US

V. Phone/Fax

Practice location:
  • Phone: 956-565-3002
  • Fax: 956-260-0208
Mailing address:
  • Phone: 956-565-3002
  • Fax: 956-260-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number103051
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: