Provider Demographics
NPI:1609977727
Name:GOODEN, RONALD D (AUD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:GOODEN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:105 CARTER PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1152
Practice Address - Country:US
Practice Address - Phone:864-482-3122
Practice Address - Fax:864-482-3152
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3995231H00000X
FLMEAY1296231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA701022879AMedicaid
SCSAG021Medicaid
FLDQ422ZOtherMEDICARE PTAN
FL002730800Medicaid
GA701022879BMedicaid
GA701022879AMedicaid