Provider Demographics
NPI:1649720442
Name:GOMEZ, CLIFF ANTHONY (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:CLIFF
Middle Name:ANTHONY
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-6203
Mailing Address - Country:US
Mailing Address - Phone:504-491-1623
Mailing Address - Fax:
Practice Address - Street 1:501 OLD COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5126
Practice Address - Country:US
Practice Address - Phone:985-542-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist