Provider Demographics
NPI:1457551962
Name:GOETTSCHE, CHERYL ANNE (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANNE
Last Name:GOETTSCHE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANNE
Other - Last Name:GOETTSCHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:526 COUNTY ROUTE 21
Mailing Address - City:WINDHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12496-5829
Mailing Address - Country:US
Mailing Address - Phone:518-265-5227
Mailing Address - Fax:
Practice Address - Street 1:526 COUNTY ROUTE 21
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NY
Practice Address - Zip Code:12496-5829
Practice Address - Country:US
Practice Address - Phone:518-265-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist