Basic Information
Provider Information | |||||||||
NPI: | 1306498183 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GUAY | ||||||||
FirstName: | CARRIE | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | SLP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7591 TYLERS PLACE BLVD | ||||||||
Address2: |   | ||||||||
City: | WEST CHESTER | ||||||||
State: | OH | ||||||||
PostalCode: | 450696308 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5137556600 | ||||||||
FaxNumber: | 5137553762 | ||||||||
Practice Location | |||||||||
Address1: | 3817 COLONEL GLENN HWY | ||||||||
Address2: |   | ||||||||
City: | BEAVERCREEK | ||||||||
State: | OH | ||||||||
PostalCode: | 453242031 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9374279200 | ||||||||
FaxNumber: | 9374279203 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/12/2019 | ||||||||
LastUpdateDate: | 07/17/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/17/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP.13916 | OH | Y |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   | 235Z00000X | 20191027-SP | OH | N |   | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |   |
ID Information
ID | Type | State | Issuer | Description | 0406425 | 05 | OH |   | MEDICAID | AB7360731 | 01 | OH | MEDICARE PIN | OTHER |