Provider Demographics
NPI:1518591627
Name:GOHLKE, DILANA LEE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:DILANA
Middle Name:LEE
Last Name:GOHLKE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 294324
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-4324
Mailing Address - Country:US
Mailing Address - Phone:830-257-1108
Mailing Address - Fax:830-257-1137
Practice Address - Street 1:306 WESLEY DR STE A
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5822
Practice Address - Country:US
Practice Address - Phone:830-257-1108
Practice Address - Fax:830-257-1137
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16398OtherTDLR