Provider Demographics
NPI:1184743643
Name:GOLD, EVELYN A (MS CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:A
Last Name:GOLD
Suffix:
Gender:F
Credentials:MS CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:710 CROWELLS BOG ROAD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631
Mailing Address - Country:US
Mailing Address - Phone:508-896-9005
Mailing Address - Fax:
Practice Address - Street 1:27 PARK ST
Practice Address - Street 2:CAPE COD HOSPITAL REHABILITATION SERVICES
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5230
Practice Address - Country:US
Practice Address - Phone:508-862-5756
Practice Address - Fax:508-862-7345
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6397235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist