Provider Demographics
NPI:1205967023
Name:GOSSAGE, NONA ANN (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:NONA
Middle Name:ANN
Last Name:GOSSAGE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 CANDLELIGHT DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5016
Mailing Address - Country:US
Mailing Address - Phone:505-293-2248
Mailing Address - Fax:
Practice Address - Street 1:5400 OBREGON RD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-1535
Practice Address - Country:US
Practice Address - Phone:505-891-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM440235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist