Provider Demographics
NPI:1194875880
Name:GUILLORY, JOSEPH A (AUD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:GUILLORY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5246
Mailing Address - Country:US
Mailing Address - Phone:337-942-3451
Mailing Address - Fax:337-942-3414
Practice Address - Street 1:318 W NORTH ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5246
Practice Address - Country:US
Practice Address - Phone:337-942-3451
Practice Address - Fax:337-942-3414
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56231HA2500X, 235Z00000X, 237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1969389Medicaid
LA4600002OtherUNITED HEALTHCARE
LA1308889Medicaid
LA56062Medicare ID - Type UnspecifiedAUDIOLOGIST
LA1308889Medicaid