Healthcare Provider Details

I. General information

NPI: 1982940953
Provider Name (Legal Business Name): GAIL ELLEN GOLD MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DELAWARE PL 21 C
CHICAGO IL
60611-1911
US

IV. Provider business mailing address

200 E DELAWARE PL 21C
CHICAGO IL
60611-1911
US

V. Phone/Fax

Practice location:
  • Phone: 312-664-6106
  • Fax:
Mailing address:
  • Phone: 312-664-6106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146-005431
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: