Provider Demographics
NPI:1245587732
Name:DOEKSEN-GOULD, DEBRA JEAN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JEAN
Last Name:DOEKSEN-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 1:104 STAMPEDE
Mailing Address - Street 2:WESTON COUNTY CHILDREN'S CENTER
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-3037
Mailing Address - Country:US
Mailing Address - Phone:307-745-4560
Mailing Address - Fax:
Practice Address - Street 1:104 STAMPEDE ST
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-3037
Practice Address - Country:US
Practice Address - Phone:307-745-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist