Provider Demographics
NPI:1730462029
Name:GOTHAM, HILLARY R (MS)
Entity type:Individual
Prefix:MS
First Name:HILLARY
Middle Name:R
Last Name:GOTHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ENTERPRISE AVE
Mailing Address - Street 2:APT. 936
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2911
Mailing Address - Country:US
Mailing Address - Phone:281-932-9607
Mailing Address - Fax:
Practice Address - Street 1:5313 DECKER DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-1413
Practice Address - Country:US
Practice Address - Phone:281-838-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107301235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist