MEDICARE: ELIZABETH GUYETTE

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	20076	CA

General Provider Information

NPI Number	:	1932351087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GUYETTE

Provider Business Mailing Address
First Line	:	3701 BROADWAY
Second Line	:	SUITE 105
City	:	OAKLAND
State	:	CA
Zip	:	94611-5613
Country	:	US
Telephone Number	:	510-752-3064
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 BROADWAY
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-5613
Country	:	US
Telephone Number	:	510-752-3064
Fax Number	:

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/25/2016

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Directions to “ ELIZABETH GUYETTE ” Practice Location

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