Provider Demographics
NPI:1285360792
Name:GOLD, KATHERINE ROSE (SLP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSE
Last Name:GOLD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E WASHINGTON AVE APT 418
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3620
Mailing Address - Country:US
Mailing Address - Phone:347-585-2381
Mailing Address - Fax:
Practice Address - Street 1:1050 E WASHINGTON AVE APT 418
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3620
Practice Address - Country:US
Practice Address - Phone:347-585-2381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist