Provider Demographics
NPI:1699814178
Name:GUTIERREZ, CYNTHIA A (MACCSLP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MACCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 N MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2206
Mailing Address - Country:US
Mailing Address - Phone:956-661-0777
Mailing Address - Fax:956-973-8972
Practice Address - Street 1:3005 E BUSINESS HIGHWAY 83
Practice Address - Street 2:UNIT A
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3623
Practice Address - Country:US
Practice Address - Phone:956-461-2041
Practice Address - Fax:956-461-2072
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11798235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156832102Medicaid
TX86321TOtherBCBS INDIV NUMBER