Provider Demographics
NPI:1235539974
Name:GOSS, LAURE (MEDMS-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURE
Middle Name:
Last Name:GOSS
Suffix:
Gender:F
Credentials:MEDMS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 SW DORIC CT
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6843
Mailing Address - Country:US
Mailing Address - Phone:772-530-4115
Mailing Address - Fax:
Practice Address - Street 1:1331 SW DORIC CT
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6843
Practice Address - Country:US
Practice Address - Phone:772-530-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14412235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist