Provider Demographics
NPI:1538216791
Name:GOSSMAN, MARY A (MA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:GOSSMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-498-6509
Mailing Address - Fax:402-498-6357
Practice Address - Street 1:555 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2136
Practice Address - Country:US
Practice Address - Phone:402-498-6509
Practice Address - Fax:402-498-6357
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1585075Medicaid
IA2585083Medicaid
IA3585075Medicaid
IA7585075Medicaid
IA6585075Medicaid
NE36841OtherBCBS BT
IA4585075Medicaid
IA0585083Medicaid
IA1585083Medicaid
IA0585075Medicaid
IA3585083Medicaid
IA5585075Medicaid
IA8585075Medicaid
IA9585075Medicaid
IA2585075Medicaid
NE36842OtherBCBS ENT
IA6585075Medicaid
IA1585075Medicaid