Provider Demographics
NPI:1174718720
Name:GOHL, GLENNA GOODMAN (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:GLENNA
Middle Name:GOODMAN
Last Name:GOHL
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10060 HOOKER ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6746
Mailing Address - Country:US
Mailing Address - Phone:303-460-8442
Mailing Address - Fax:
Practice Address - Street 1:10060 HOOKER ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6746
Practice Address - Country:US
Practice Address - Phone:303-460-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00832386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist