Provider Demographics
NPI:1164545661
Name:GOFF, AMBER LYNN LINGLE (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:LYNN LINGLE
Last Name:GOFF
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BRUCE ST.
Mailing Address - Street 2:STE 101
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034
Mailing Address - Country:US
Mailing Address - Phone:501-470-7457
Mailing Address - Fax:501-504-2105
Practice Address - Street 1:2200 BRUCE ST. STE 101
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034
Practice Address - Country:US
Practice Address - Phone:501-470-7457
Practice Address - Fax:501-504-2105
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR12100498OtherASHA
AR2428OtherLICENSE