Provider Demographics
NPI:1831755487
Name:GOSS, HEIDI JO (MS/LBS)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JO
Last Name:GOSS
Suffix:
Gender:F
Credentials:MS/LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 ALFARATA RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-7106
Mailing Address - Country:US
Mailing Address - Phone:717-994-9836
Mailing Address - Fax:
Practice Address - Street 1:25 ROTHERMEL DR
Practice Address - Street 2:
Practice Address - City:YEAGERTOWN
Practice Address - State:PA
Practice Address - Zip Code:17099-9707
Practice Address - Country:US
Practice Address - Phone:717-248-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003159103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst