Healthcare Provider Details

I. General information

NPI: 1780178574
Provider Name (Legal Business Name): CARISSA N GUILEY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CARISSA N ANDERSON

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17791 FJORD DR NE STE 138
POULSBO WA
98370-8483
US

IV. Provider business mailing address

17791 FJORD DR NE STE 138
POULSBO WA
98370-8483
US

V. Phone/Fax

Practice location:
  • Phone: 615-767-4639
  • Fax: 360-824-6944
Mailing address:
  • Phone: 615-767-4639
  • Fax: 360-824-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-316642
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: