Provider Demographics
NPI:1134589989
Name:GODAR, SHELLY POMPLIN (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:POMPLIN
Last Name:GODAR
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 HIGHLAND AVE
Mailing Address - Street 2:WAISMAN CENTER CLINICS
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2274
Mailing Address - Country:US
Mailing Address - Phone:608-263-3301
Mailing Address - Fax:608-265-7429
Practice Address - Street 1:1500 HIGHLAND AVE
Practice Address - Street 2:WAISMAN CENTER CLINICS
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2274
Practice Address - Country:US
Practice Address - Phone:608-263-3301
Practice Address - Fax:608-265-7429
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156-376231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist