Provider Demographics
NPI:1437644093
Name:GOGGINS, PATRICIA HENRY (SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:HENRY
Last Name:GOGGINS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 RAND AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9126
Mailing Address - Country:US
Mailing Address - Phone:251-210-1632
Mailing Address - Fax:251-625-3152
Practice Address - Street 1:8909 RAND AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9126
Practice Address - Country:US
Practice Address - Phone:251-210-1632
Practice Address - Fax:251-625-3152
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4276235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4276OtherSTATE LICENSE