Provider Demographics
NPI:1730460387
Name:GOETSCH, JASON LAYNE (HID)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LAYNE
Last Name:GOETSCH
Suffix:
Gender:M
Credentials:HID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AMERICAN BLVD W
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1120
Mailing Address - Country:US
Mailing Address - Phone:952-888-2930
Mailing Address - Fax:
Practice Address - Street 1:200 AMERICAN BLVD W
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1120
Practice Address - Country:US
Practice Address - Phone:952-888-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2651237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist