Provider Demographics
NPI:1457757379
Name:GOULD, REGINA MARSHA (MA,CCC-A)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:MARSHA
Last Name:GOULD
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:MS
Other - First Name:REGINA
Other - Middle Name:GOULD
Other - Last Name:MUHLBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2285 CLAYTON CIR
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-8307
Mailing Address - Country:US
Mailing Address - Phone:720-290-5894
Mailing Address - Fax:720-494-9555
Practice Address - Street 1:4745 ARAPAHOE AVE STE 130
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303
Practice Address - Country:US
Practice Address - Phone:303-443-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO145237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO145OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES
01009885OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION