Provider Demographics
NPI:1063994499
Name:GUAY, DUSTIN JAMES (CCC-SLP)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JAMES
Last Name:GUAY
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 EXPOSITION BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-5060
Mailing Address - Country:US
Mailing Address - Phone:267-893-8039
Mailing Address - Fax:
Practice Address - Street 1:2908 EXPOSITION BLVD APT 4
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-5060
Practice Address - Country:US
Practice Address - Phone:267-893-8039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-01
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist