MEDICARE: MS. KATHY B GUNTER 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	822	GA

General Provider Information

NPI Number	:	1316039233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHY B GUNTER CCC-SLP

Provider Business Mailing Address
First Line	:	1495 LAFAYETTE PARKWAY
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30240-2552
Country	:	US
Telephone Number	:	706-883-7322
Fax Number	:	706-883-8187

Provider Business Practice Location Address
First Line	:	1495 LAFAYETTE PARKWAY
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-2552
Country	:	US
Telephone Number	:	706-883-7322
Fax Number	:	706-883-8187

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/21/2022

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