Provider Demographics
NPI:1750638466
Name:GOTWAY, RHONDA
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:GOTWAY
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 1:101 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRAND CHAIN
Mailing Address - State:IL
Mailing Address - Zip Code:62941-3507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E 2ND ST
Practice Address - Street 2:
Practice Address - City:GRAND CHAIN
Practice Address - State:IL
Practice Address - Zip Code:62941-3507
Practice Address - Country:US
Practice Address - Phone:618-634-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005853235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist