Provider Demographics
NPI:1356089163
Name:GOMEZ, SCOTT RICHARD
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:RICHARD
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ECU COMMUNITY SCHOOL
Mailing Address - Street 2:811 HOWELL STREET
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-737-5600
Mailing Address - Fax:
Practice Address - Street 1:ECU COMMUNITY SCHOOL
Practice Address - Street 2:811 HOWELL STREET
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-737-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist