Provider Demographics
NPI:1679712632
Name:GOFF, LEAH CORINNE (MACCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:CORINNE
Last Name:GOFF
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 FM 43
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-9774
Mailing Address - Country:US
Mailing Address - Phone:361-855-0092
Mailing Address - Fax:
Practice Address - Street 1:1306 FM 43
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-9774
Practice Address - Country:US
Practice Address - Phone:361-855-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101242OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION