Individual
CARRIE GUILLAUME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCCSLP
Contact information
Practice address
2927 LAKE AVE, FORT WAYNE, IN 46805-5415
(260) 452-4062
Mailing address
1319 SHIRAZ CT, FORT WAYNE, IN 46845-9052
(260) 452-4062
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22002491A
IN
Other
Enumeration date
02/03/2021
Last updated
02/03/2021
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