Basic Information
| Provider Information | |||||||||
| NPI: | 1205112802 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUTTENPLAN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | DELEONE-THOMAS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CCC-SLP | ||||||||
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| OtherLastName: | THOMAS | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | DELEONE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 N MARIO CAPECCHI DR | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841131103 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6135 ROOSEVELT HWY | ||||||||
| Address2: | |||||||||
| City: | WARM SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 318301000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066555432 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2011 | ||||||||
| LastUpdateDate: | 11/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | PCET001697 | GA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 9064857-4102 | UT | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.