Provider Demographics
NPI:1770641680
Name:GOULET, CHRISTINE (AUD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:GOULET
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2184
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72902-2184
Mailing Address - Country:US
Mailing Address - Phone:479-709-7405
Mailing Address - Fax:479-709-7406
Practice Address - Street 1:1500 DODSON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5182
Practice Address - Country:US
Practice Address - Phone:479-709-7470
Practice Address - Fax:479-709-7406
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA148237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y499OtherAR BLUECROSS BLUESHIELD
AR5Y499OtherAR BLUECROSS BLUESHIELD