Provider Demographics
NPI:1700021631
Name:GOFF, ANN M (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:GOFF
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 WALLACE DR
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1238
Mailing Address - Country:US
Mailing Address - Phone:708-305-5121
Mailing Address - Fax:708-798-7980
Practice Address - Street 1:16532 OAK PARK AVE
Practice Address - Street 2:STE 202
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1918
Practice Address - Country:US
Practice Address - Phone:708-444-2900
Practice Address - Fax:708-444-7760
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002416A231H00000X
IL147-000611231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL326971OtherINACTIVE MEDICARE NUMBER