MEDICARE: MRS. BRITT TAYLENE GOMER MS CCC-SLP

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	235Z00000X	Speech-Language Pathologist	12124645	CO

General Provider Information

NPI Number	:	1639369408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRITT TAYLENE GOMER MS CCC-SLP

Provider Business Mailing Address
First Line	:	109 BOBWHITE LOOP
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-9474
Country	:	US
Telephone Number	:	719-276-9453
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 BOBWHITE LOOP
Second Line	:
City	:	CANON CITY
State	:	CO
Zip	:	81212-9474
Country	:	US
Telephone Number	:	719-276-9453
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	07/27/2007

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Directions to “ MRS. BRITT TAYLENE GOMER MS CCC-SLP” Practice Location

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