Provider Demographics
NPI:1427555721
Name:GOFORTH, KARA L (MS, CCC-SLP/A)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:L
Last Name:GOFORTH
Suffix:
Gender:F
Credentials:MS, CCC-SLP/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 TAZEWELL ST
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2316
Mailing Address - Country:US
Mailing Address - Phone:276-228-3561
Mailing Address - Fax:276-228-7277
Practice Address - Street 1:330 TAZEWELL ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2316
Practice Address - Country:US
Practice Address - Phone:276-228-3561
Practice Address - Fax:276-228-7277
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist