Provider Demographics
NPI:1710168109
Name:GOEDEKER, KATHERINE CERN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:CERN
Last Name:GOEDEKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7226 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130
Mailing Address - Country:US
Mailing Address - Phone:314-629-8548
Mailing Address - Fax:
Practice Address - Street 1:7226 STANFORD AVE
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130
Practice Address - Country:US
Practice Address - Phone:314-629-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program