Provider Demographics
NPI:1699156240
Name:GUITREAU, ELIZABETH D (MS, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:D
Last Name:GUITREAU
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 1:2115 N SEDGWICK ST
Mailing Address - Street 2:APT 3C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4778
Mailing Address - Country:US
Mailing Address - Phone:225-323-2156
Mailing Address - Fax:
Practice Address - Street 1:2115 N SEDGWICK ST
Practice Address - Street 2:APT 3C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4778
Practice Address - Country:US
Practice Address - Phone:225-323-2156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003070235Z00000X
LA7106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist