Individual
ELIZABETH A GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-A
Contact information
Practice address
421 CAMELOT DR, FOND DU LAC, WI 54935-4560
(920) 926-8460
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
366156
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41143200
—
WI
01
—
640004449
RAILROAD MEDICARE
WI
Enumeration date
11/03/2005
Last updated
02/16/2016
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