Provider Demographics
NPI:1982621819
Name:GOEBEL, EILEEN L (MA CCC-A)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:L
Last Name:GOEBEL
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 1:5303 50TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-5823
Mailing Address - Country:US
Mailing Address - Phone:806-799-8950
Mailing Address - Fax:806-799-8939
Practice Address - Street 1:5303 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-5823
Practice Address - Country:US
Practice Address - Phone:860-799-8950
Practice Address - Fax:806-792-9404
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11668587OtherCAQH
COC808216Medicare PIN