Provider Demographics
NPI:1215661657
Name:GUEVARA, LARA ELISE (CF-SLP)
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:ELISE
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 E CALLE MERCURIO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-5643
Mailing Address - Country:US
Mailing Address - Phone:520-891-5658
Mailing Address - Fax:
Practice Address - Street 1:1701 W EL RIO DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1909
Practice Address - Country:US
Practice Address - Phone:520-225-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist