Healthcare Provider Details

I. General information

NPI: 1528454782
Provider Name (Legal Business Name): AMY BROOKE GOLD MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FERROUS CT
CHESTER NJ
07930-2300
US

IV. Provider business mailing address

6 FERROUS CT
CHESTER NJ
07930-2300
US

V. Phone/Fax

Practice location:
  • Phone: 201-400-8117
  • Fax:
Mailing address:
  • Phone: 201-400-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: