Provider Demographics
NPI:1225382088
Name:GOSTOW, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:GOSTOW
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 1:333 OLD MILL ROAD
Mailing Address - Street 2:#314
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110
Mailing Address - Country:US
Mailing Address - Phone:805-698-6346
Mailing Address - Fax:
Practice Address - Street 1:333 OLD MILL ROAD
Practice Address - Street 2:#314
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110
Practice Address - Country:US
Practice Address - Phone:805-698-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist