MEDICARE: MRS. ANNETTE MARIE GUIDRY-DUNBAR 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	2141	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	748931	OTHER	AZ	STATE AHCCCS

General Provider Information

NPI Number	:	1326173170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNETTE MARIE GUIDRY-DUNBAR MS,CCC-SLP

Provider Business Mailing Address
First Line	:	1722 W PINE CONE WAY
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86303-7105
Country	:	US
Telephone Number	:	928-710-6475
Fax Number	:

Provider Business Practice Location Address
First Line	:	1722 W PINE CONE WAY
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86303-7105
Country	:	US
Telephone Number	:	928-710-6475
Fax Number	:

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. ANNETTE MARIE GUIDRY-DUNBAR MS,CCC-SLP” Practice Location

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