Provider Demographics
NPI:1396919965
Name:GOSS, MONCIA LYNN (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MONCIA
Middle Name:LYNN
Last Name:GOSS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2529
Mailing Address - Country:US
Mailing Address - Phone:609-471-2583
Mailing Address - Fax:856-206-9450
Practice Address - Street 1:19 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2529
Practice Address - Country:US
Practice Address - Phone:609-471-2583
Practice Address - Fax:856-206-9450
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00547500235Z00000X
PASL005241L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist