MEDICARE: MRS. ANDREA NICOLE GUIDETTI MS CCC-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	6877	MA

General Provider Information

NPI Number	:	1124211461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA NICOLE GUIDETTI MS CCC-SLP

Provider Business Mailing Address
First Line	:	3320 AUBURN AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-1813
Country	:	US
Telephone Number	:	508-333-4258
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 AUBURN AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-1813
Country	:	US
Telephone Number	:	508-333-4258
Fax Number	:

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

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	02/20/2010

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