Provider Demographics
NPI:1043568173
Name:GODOVIN, JESSICA ANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:GODOVIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:AUDIOLOGY DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:3855 W CHESTER PIKE STE 280
Practice Address - Street 2:AUDIOLOGY DEPARTMENT
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2304
Practice Address - Country:US
Practice Address - Phone:610-557-4800
Practice Address - Fax:610-557-4816
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2013-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEO2-0000193231H00000X, 231HA2400X, 231HA2500X, 237600000X
PAAT006265231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter