Provider Demographics
NPI:1689911455
Name:GOAD, PRINCESS VENESSA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PRINCESS
Middle Name:VENESSA
Last Name:GOAD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5431
Mailing Address - Country:US
Mailing Address - Phone:407-409-9154
Mailing Address - Fax:
Practice Address - Street 1:612 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5431
Practice Address - Country:US
Practice Address - Phone:407-409-9154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist