Provider Demographics
NPI:1063547347
Name:GUILE, TATIANA (SLP)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:GUILE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2658 WHITMAN DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3712
Mailing Address - Country:US
Mailing Address - Phone:302-454-2047
Mailing Address - Fax:302-454-5444
Practice Address - Street 1:200 TYRE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7136
Practice Address - Country:US
Practice Address - Phone:302-454-2047
Practice Address - Fax:302-454-5444
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO1-0000716235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000955467Medicaid