Provider Demographics
NPI:1144460346
Name:GUTHRIE, JENITA L (AUDIOLOGY)
Entity type:Individual
Prefix:
First Name:JENITA
Middle Name:L
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:AUDIOLOGY
Other - Prefix:
Other - First Name:JENITA
Other - Middle Name:L
Other - Last Name:GUTHRIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUDIOLOGY
Mailing Address - Street 1:4736 BRYANT IRVIN RD
Mailing Address - Street 2:SUITE 702
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3625
Mailing Address - Country:US
Mailing Address - Phone:817-263-1971
Mailing Address - Fax:817-263-2365
Practice Address - Street 1:4736 BRYANT IRVIN RD
Practice Address - Street 2:SUITE 702
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3625
Practice Address - Country:US
Practice Address - Phone:817-263-1971
Practice Address - Fax:817-263-2365
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50726231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50726OtherTX LICENSE