Provider Demographics
NPI:1194978742
Name:GURRISTER, MARIA (MS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GURRISTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 E 3900 S STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1772
Mailing Address - Country:US
Mailing Address - Phone:801-308-0400
Mailing Address - Fax:801-308-0401
Practice Address - Street 1:2120 E 3900 S STE 100
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-1772
Practice Address - Country:US
Practice Address - Phone:801-308-0400
Practice Address - Fax:801-308-0401
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111202-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist