Provider Demographics
NPI:1467623421
Name:GOSU, GOUTHAM K (AUD, CCC-A, F-AAA)
Entity Type:Individual
Prefix:DR
First Name:GOUTHAM
Middle Name:K
Last Name:GOSU
Suffix:
Gender:M
Credentials:AUD, CCC-A, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 S SHARON AMITY RD
Mailing Address - Street 2:STE 208
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2842
Mailing Address - Country:US
Mailing Address - Phone:704-944-4283
Mailing Address - Fax:
Practice Address - Street 1:135 S SHARON AMITY RD
Practice Address - Street 2:STE 208
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2842
Practice Address - Country:US
Practice Address - Phone:704-944-4283
Practice Address - Fax:980-819-7817
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005915231H00000X
NC11105231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist