Provider Demographics
NPI:1770659617
Name:GOEHMAN, AVERY (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:GOEHMAN
Suffix:
Gender:M
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 S. 65 HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340
Mailing Address - Country:US
Mailing Address - Phone:660-886-7431
Mailing Address - Fax:
Practice Address - Street 1:2305 S. 65 HIGHWAY
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340
Practice Address - Country:US
Practice Address - Phone:660-886-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist