Provider Demographics
NPI:1548760853
Name:GOODALE, STEPHENEI DAWN (AUDIOPROSTHOLOGIST)
Entity Type:Individual
Prefix:
First Name:STEPHENEI
Middle Name:DAWN
Last Name:GOODALE
Suffix:
Gender:F
Credentials:AUDIOPROSTHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 N NAVARRO ST STE L
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3937
Mailing Address - Country:US
Mailing Address - Phone:361-575-9911
Mailing Address - Fax:361-575-9977
Practice Address - Street 1:2806 N NAVARRO ST STE L
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3937
Practice Address - Country:US
Practice Address - Phone:361-575-9977
Practice Address - Fax:361-575-9977
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80270237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist