Provider Demographics
NPI:1952518623
Name:GOODING, JIMMY R (BOARD CERTIFIED HEAR)
Entity Type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:R
Last Name:GOODING
Suffix:
Gender:M
Credentials:BOARD CERTIFIED HEAR
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:R
Other - Last Name:GOODING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2211 ONEIDA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-5629
Mailing Address - Country:US
Mailing Address - Phone:937-275-6364
Mailing Address - Fax:
Practice Address - Street 1:2211 ONEIDA AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-5629
Practice Address - Country:US
Practice Address - Phone:937-275-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH551237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH551OtherSTATE LICENSE NUMBER
OH0451265Medicaid
OH551OtherSTATE LICENSE NUMBER