Provider Demographics
NPI:1841395852
Name:GOSS, RITA JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:JEAN
Last Name:GOSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N DELLROSE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3920
Mailing Address - Country:US
Mailing Address - Phone:316-686-4404
Mailing Address - Fax:316-686-2544
Practice Address - Street 1:140 N DELLROSE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3920
Practice Address - Country:US
Practice Address - Phone:316-686-4404
Practice Address - Fax:316-686-2544
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical