Provider Demographics
NPI:1902046311
Name:GUTIERREZ, DOLLY CRISTINA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DOLLY
Middle Name:CRISTINA
Last Name:GUTIERREZ
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 1:13529 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1037
Mailing Address - Country:US
Mailing Address - Phone:347-453-6346
Mailing Address - Fax:
Practice Address - Street 1:13529 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1037
Practice Address - Country:US
Practice Address - Phone:347-453-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018511-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist