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General NPI Number Information
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NPI Number | 1104397041
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Entity Type | Individual
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Provider Name | CONRAD GOLD MA, CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 1500 SPRING STREET
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City | PETOSKEY
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State | MI
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Zip | 49770-3125
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Country | US
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Telephone | 231-347-1678
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 WAUKAZOO AVE
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City | PETOSKEY
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State | MI
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Zip | 49770-3125
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Country | US
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Telephone | 231-348-9148
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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