Provider Demographics
NPI:1033466198
Name:GOULD, CORIE
Entity Type:Individual
Prefix:
First Name:CORIE
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5995 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2104
Mailing Address - Country:US
Mailing Address - Phone:586-254-5454
Mailing Address - Fax:586-254-6066
Practice Address - Street 1:1250 GRAND AVE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94610-1002
Practice Address - Country:US
Practice Address - Phone:510-655-7880
Practice Address - Fax:510-655-3379
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program