Provider Demographics
NPI:1184842767
Name:GOSSER, NICOLE M (CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:GOSSER
Suffix:
Gender:F
Credentials:CCC, SLP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:AMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC, SLP
Mailing Address - Street 1:2660 EL RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4543
Mailing Address - Country:US
Mailing Address - Phone:262-784-5401
Mailing Address - Fax:
Practice Address - Street 1:2895 S MOORLAND RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-3743
Practice Address - Country:US
Practice Address - Phone:262-782-9015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2373-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist