Basic Information
| Provider Information | |||||||||
| NPI: | 1003017773 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOULD | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 168 FOISY HILL RD | ||||||||
| Address2: | |||||||||
| City: | CLAREMONT | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037434325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035431972 | ||||||||
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| Practice Location | |||||||||
| Address1: | 168 FOISY HILL RD | ||||||||
| Address2: | |||||||||
| City: | CLAREMONT | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037434325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035431972 | ||||||||
| FaxNumber: | 6035424034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 0614 | NH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 30400154 | 05 | NH | MEDICAID |