Provider Demographics
NPI:1891738969
Name:GOLD, BETSY R (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:R
Last Name:GOLD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GLENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1363
Mailing Address - Country:US
Mailing Address - Phone:215-322-8730
Mailing Address - Fax:215-322-7675
Practice Address - Street 1:25 GLENFIELD DR
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1363
Practice Address - Country:US
Practice Address - Phone:215-322-8730
Practice Address - Fax:215-322-7675
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASLOOOO47L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist