Individual
MRS. JODI L GOGOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSCCCSLP
Contact information
Practice address
10315 DAWSONS CREEK BLVD, STE I, FORT WAYNE, IN 46825-1914
(260) 450-3617
(260) 436-4946
Mailing address
10315 DAWSONS CREEK BLVD, STE I, FORT WAYNE, IN 46825-1914
(260) 450-3617
(260) 436-4946
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22002999A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
870763354
TAX ID
IN
Enumeration date
09/21/2006
Last updated
11/04/2010
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