MEDICARE: SHANNA GUETTA SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	13779	CA

General Provider Information

NPI Number	:	1003459900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNA GUETTA SLP

Provider Business Mailing Address
First Line	:	1385 CEDAR ST
Second Line	:
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-4755
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 CEDAR ST
Second Line	:
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-4755
Country	:	US
Telephone Number	:	650-283-5547
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	10/23/2019

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Directions to “ SHANNA GUETTA SLP” Practice Location

Language	Start Address	Practice Location

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