Provider Demographics
NPI:1427255157
Name:GUTIERREZ, AMY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 N 10TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3385
Mailing Address - Country:US
Mailing Address - Phone:956-393-1091
Mailing Address - Fax:
Practice Address - Street 1:6400 N 10TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3385
Practice Address - Country:US
Practice Address - Phone:956-393-1091
Practice Address - Fax:956-687-9102
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24922235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219544801Medicaid