Provider Demographics
NPI:1013915545
Name:LANDAU GOODMAN, KATHY (AUD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:LANDAU GOODMAN
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 1:916 MONTGOMERY AVE
Mailing Address - Street 2:MAIN LINE AUDIOLOGY CONSULTANTS, PC
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072
Mailing Address - Country:US
Mailing Address - Phone:610-667-3277
Mailing Address - Fax:610-667-1662
Practice Address - Street 1:916 MONTGOMERY AVE
Practice Address - Street 2:MAIN LINE AUDIOLOGY CONSULTANTS, PC
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072
Practice Address - Country:US
Practice Address - Phone:610-667-3277
Practice Address - Fax:610-667-1662
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000310L237600000X
NJ41YA00031600237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0049105000OtherKEYSTONE
PA0049105000OtherKEYSTONE
NJ052358PGAMedicare ID - Type Unspecified