Provider Demographics
NPI:1285879692
Name:GOULD, RENEE LAUREN (SLP)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:LAUREN
Last Name:GOULD
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 1:1 OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3750
Mailing Address - Country:US
Mailing Address - Phone:347-563-6776
Mailing Address - Fax:
Practice Address - Street 1:1 OVERLOOK AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3750
Practice Address - Country:US
Practice Address - Phone:347-563-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0141841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist