Provider Demographics
NPI:1588183016
Name:GOSA, TERRINA M
Entity Type:Individual
Prefix:
First Name:TERRINA
Middle Name:M
Last Name:GOSA
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 1:3530 AVENUE OF THE CITIES
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4419
Mailing Address - Country:US
Mailing Address - Phone:309-743-8478
Mailing Address - Fax:
Practice Address - Street 1:3530 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4419
Practice Address - Country:US
Practice Address - Phone:309-743-8478
Practice Address - Fax:309-757-3521
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist