Provider Demographics
NPI:1588293997
Name:DEGUZMAN, CAROLINE (SLP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 TAYLOR MOUNTAIN PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6182
Mailing Address - Country:US
Mailing Address - Phone:707-595-8581
Mailing Address - Fax:
Practice Address - Street 1:2255 TAYLOR MOUNTAIN PL
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-6182
Practice Address - Country:US
Practice Address - Phone:707-595-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist