Provider Demographics
NPI:1639369408
Name:GOMER, BRITT TAYLENE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:BRITT
Middle Name:TAYLENE
Last Name:GOMER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 BOBWHITE LOOP
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-9474
Mailing Address - Country:US
Mailing Address - Phone:719-276-9453
Mailing Address - Fax:
Practice Address - Street 1:109 BOBWHITE LOOP
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-9474
Practice Address - Country:US
Practice Address - Phone:719-276-9453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12124645235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist