Provider Demographics
NPI:1003179607
Name:GOFFUS, ALEXA J (SLP)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:J
Last Name:GOFFUS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:J
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:5362 STATE ROUTE 183
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:OH
Mailing Address - Zip Code:44643
Mailing Address - Country:US
Mailing Address - Phone:330-866-9225
Mailing Address - Fax:330-866-2572
Practice Address - Street 1:5156 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2663
Practice Address - Country:US
Practice Address - Phone:330-478-1752
Practice Address - Fax:330-478-1763
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2930574Medicaid
OH3055563Medicaid