Provider Demographics
NPI:1447265855
Name:GOSTOMELSKY, SHERI (AUD)
Entity type:Individual
Prefix:DR
First Name:SHERI
Middle Name:
Last Name:GOSTOMELSKY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAKE COOK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5607
Mailing Address - Country:US
Mailing Address - Phone:847-945-4907
Mailing Address - Fax:
Practice Address - Street 1:400 LAKE COOK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5607
Practice Address - Country:US
Practice Address - Phone:847-945-4907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04927037OtherBLUE CROSS BLUE SHIELD
ILK45321Medicare PIN