Provider Demographics
NPI:1891946281
Name:GOSSERAND, KIMBERLY S (MED)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:GOSSERAND
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 PRENTISS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-2220
Mailing Address - Country:US
Mailing Address - Phone:225-715-7123
Mailing Address - Fax:
Practice Address - Street 1:4118 PRENTISS AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-2220
Practice Address - Country:US
Practice Address - Phone:225-715-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-04
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist