Provider Demographics
NPI:1740306604
Name:GOOCH, LYNN M (SLP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:GOOCH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 CHRISTY LYNN DR APT 8
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-1886
Mailing Address - Country:US
Mailing Address - Phone:304-843-1730
Mailing Address - Fax:
Practice Address - Street 1:840 LEE RD
Practice Address - Street 2:
Practice Address - City:FOLLANSBEE
Practice Address - State:WV
Practice Address - Zip Code:26037-1783
Practice Address - Country:US
Practice Address - Phone:304-527-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0386235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist