MEDICARE: GOSS CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1306546684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOSS CONSULTING LLC

Provider Business Mailing Address
First Line	:	1620 KODA DR
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-8608
Country	:	US
Telephone Number	:	847-401-9618
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 KODA DR
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-8608
Country	:	US
Telephone Number	:	847-401-9618
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER GOSS
Credential	:	LCPC
Telephone Number	:	847-401-9618

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	12/31/2023

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Directions to “GOSS CONSULTING LLC ” Practice Location

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