Provider Demographics
NPI:1912042441
Name:GOLD, CHERYLL ANNE (AUD)
Entity Type:Individual
Prefix:MRS
First Name:CHERYLL
Middle Name:ANNE
Last Name:GOLD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S STAPLES ST
Mailing Address - Street 2:STE 205
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3844
Mailing Address - Country:US
Mailing Address - Phone:361-854-2500
Mailing Address - Fax:361-854-4587
Practice Address - Street 1:5959 S STAPLES ST
Practice Address - Street 2:STE 205
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3844
Practice Address - Country:US
Practice Address - Phone:361-854-2500
Practice Address - Fax:361-854-4587
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51546231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204549405Medicaid
TX204549404Medicaid