Provider Demographics
NPI:1043947054
Name:GOULD, EILEEN SIMPSON (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:SIMPSON
Last Name:GOULD
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 ANTISDEL PL NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3433
Mailing Address - Country:US
Mailing Address - Phone:616-633-9810
Mailing Address - Fax:
Practice Address - Street 1:216 ANTISDEL PL NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3433
Practice Address - Country:US
Practice Address - Phone:616-633-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101001083235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist