Provider Demographics
NPI:1255614673
Name:GOTCHER, CLARISSA V (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:V
Last Name:GOTCHER
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 1:1310 MOONLIGHT TRL
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-7920
Mailing Address - Country:US
Mailing Address - Phone:940-231-5195
Mailing Address - Fax:
Practice Address - Street 1:1310 MOONLIGHT TRL
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-7920
Practice Address - Country:US
Practice Address - Phone:940-231-5195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist