Provider Demographics
NPI:1518408830
Name:GORSKI, THERESE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:
Last Name:GORSKI
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 1:1507 N GULLEY RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3473
Mailing Address - Country:US
Mailing Address - Phone:313-701-8991
Mailing Address - Fax:
Practice Address - Street 1:24750 SWANSON RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5320
Practice Address - Country:US
Practice Address - Phone:248-355-5800
Practice Address - Fax:248-355-5801
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101000250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist