Provider Demographics
NPI:1982940953
Name:GOLD, GAIL ELLEN (MS)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:ELLEN
Last Name:GOLD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E DELAWARE PL
Mailing Address - Street 2:21C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-1911
Mailing Address - Country:US
Mailing Address - Phone:312-664-6106
Mailing Address - Fax:
Practice Address - Street 1:200 E DELAWARE PL
Practice Address - Street 2:21 C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1911
Practice Address - Country:US
Practice Address - Phone:312-664-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-005431235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG43028543966OtherILLINOIS LICENSE