Provider Demographics
NPI:1255510178
Name:GOCHNOUR, ELIZABETH A (SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GOCHNOUR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-0594
Mailing Address - Country:US
Mailing Address - Phone:662-473-0012
Mailing Address - Fax:662-473-0013
Practice Address - Street 1:105 N COURT ST
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-1806
Practice Address - Country:US
Practice Address - Phone:662-473-0012
Practice Address - Fax:662-473-0013
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-27
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3049235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04901381Medicaid