Provider Demographics
NPI:1275785628
Name:GOTTERMEIER, LINDA G
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:G
Last Name:GOTTERMEIER
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 1:52 LOMB MEMORIAL DRIVE
Mailing Address - Street 2:LBJ-3123
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-5604
Mailing Address - Country:US
Mailing Address - Phone:585-475-6429
Mailing Address - Fax:585-475-6500
Practice Address - Street 1:52 LOMB MEMORIAL DRIVE
Practice Address - Street 2:LBJ-3123
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5604
Practice Address - Country:US
Practice Address - Phone:585-475-6429
Practice Address - Fax:585-475-6500
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY654-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist