Provider Demographics
NPI:1376823450
Name:GATHERCOLE, ELIZABETH K (AUD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:K
Last Name:GATHERCOLE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CORAL WAY E
Mailing Address - Street 2:UNIT C
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-2121
Mailing Address - Country:US
Mailing Address - Phone:352-328-9376
Mailing Address - Fax:
Practice Address - Street 1:127 NW 13TH ST
Practice Address - Street 2:SUITE C13
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1640
Practice Address - Country:US
Practice Address - Phone:561-620-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1575231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist