Provider Demographics
NPI:1730455692
Name:GUISON, RANDEE M (HIS)
Entity type:Individual
Prefix:
First Name:RANDEE
Middle Name:M
Last Name:GUISON
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VICTORY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068
Mailing Address - Country:US
Mailing Address - Phone:816-883-2660
Mailing Address - Fax:816-792-9819
Practice Address - Street 1:1701 S 17TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-2641
Practice Address - Country:US
Practice Address - Phone:402-475-1831
Practice Address - Fax:402-475-4257
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000973237700000X
NE786237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist