Provider Demographics
NPI:1255540829
Name:GOLD, CORISSA JORDAN-SCHWEITZ (MFA, MA)
Entity type:Individual
Prefix:MS
First Name:CORISSA
Middle Name:JORDAN-SCHWEITZ
Last Name:GOLD
Suffix:
Gender:F
Credentials:MFA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 S PIERSON CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-4926
Mailing Address - Country:US
Mailing Address - Phone:303-319-3223
Mailing Address - Fax:
Practice Address - Street 1:1173 S PIERSON CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-4926
Practice Address - Country:US
Practice Address - Phone:303-319-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9310251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based