MEDICARE: CHRISTINE GUILFOYLE 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	14150012

General Provider Information

NPI Number	:	1518513803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE GUILFOYLE CCC-SLP

Provider Business Mailing Address
First Line	:	12133 QUICK FOX CT
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-1261
Country	:	US
Telephone Number	:	703-261-3919
Fax Number	:

Provider Business Practice Location Address
First Line	:	8909 EUCLID AVE
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20111-2498
Country	:	US
Telephone Number	:	703-365-6500
Fax Number	:

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

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	08/13/2019

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Directions to “ CHRISTINE GUILFOYLE CCC-SLP” Practice Location

Language	Start Address	Practice Location

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