Provider Demographics
NPI:1316566813
Name:GOFF, SARAH CLARKSON
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:CLARKSON
Last Name:GOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ST CATHARINE
Mailing Address - State:KY
Mailing Address - Zip Code:40061
Mailing Address - Country:US
Mailing Address - Phone:502-408-1859
Mailing Address - Fax:
Practice Address - Street 1:2655 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:ST CATHARINE
Practice Address - State:KY
Practice Address - Zip Code:40061
Practice Address - Country:US
Practice Address - Phone:859-481-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1177620175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist