Provider Demographics
NPI:1528378767
Name:GOETCHIUS, KAREN E (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:E
Last Name:GOETCHIUS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:GOETCHIUS
Other - Last Name:NEVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:106 PADDOCK DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2108
Mailing Address - Country:US
Mailing Address - Phone:315-299-8964
Mailing Address - Fax:
Practice Address - Street 1:106 PADDOCK DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2108
Practice Address - Country:US
Practice Address - Phone:315-299-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012523-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012523-1OtherLICENSE - SPEECH-LANGUAGE PATHOLOGIT
09145301OtherASHA LICENSE