Healthcare Provider Details

I. General information

NPI: 1316697188
Provider Name (Legal Business Name): CATHRYN GUZMAN SPEECH THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 E 3RD ST
GILLETTE WY
82716-4023
US

IV. Provider business mailing address

902 E 3RD ST
GILLETTE WY
82716-4023
US

V. Phone/Fax

Practice location:
  • Phone: 307-756-9200
  • Fax: 888-715-6736
Mailing address:
  • Phone: 307-756-9200
  • Fax: 888-715-6736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-1097
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: