Provider Demographics
NPI:1669957239
Name:GOBEN, SUSAN G
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:GOBEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11430 KESTREL CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-9796
Mailing Address - Country:US
Mailing Address - Phone:812-454-8481
Mailing Address - Fax:
Practice Address - Street 1:11430 KESTREL CT
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-9796
Practice Address - Country:US
Practice Address - Phone:812-454-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist