Provider Demographics
NPI:1871943613
Name:GUILLEN, DONALD ANTONIO (AUD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:ANTONIO
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 YORK RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6017
Mailing Address - Country:US
Mailing Address - Phone:410-583-7021
Mailing Address - Fax:410-828-8789
Practice Address - Street 1:1447 YORK RD
Practice Address - Street 2:SUITE 312
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6017
Practice Address - Country:US
Practice Address - Phone:410-583-7021
Practice Address - Fax:410-828-8789
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01384231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist