Provider Demographics
NPI:1598953630
Name:GOSET, FREDERICK T (LD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:T
Last Name:GOSET
Suffix:
Gender:M
Credentials:LD
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 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-339-5401
Mailing Address - Fax:
Practice Address - Street 1:4027 HOYT AVE STE 101A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4972
Practice Address - Country:US
Practice Address - Phone:425-339-5401
Practice Address - Fax:425-304-1129
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001217231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALD00001217OtherSTATE LICENSE NUMBER